Discoid cutaneous lupus

Vanessa Brady is a nineteen year old, African American student at Columbia University. She tries to be healthy and take care of her body, but school is very stressful. She knows that she does not eat well and that she should get more sleep and exercise. Furthermore, Vanessa sometimes smokes with her boyfriend, Nicholas, in order to relax.

The week of finals, Vanessa notices a rash extending up her neck and the side of her face onto her forehead. The rash is disc-shaped, red, and scaly. However, the rash does not itch. Her friend, Chloe, attends the Med school and advises Vanessa to go to the doctor if the rash does not go away in a week.

After a week, the rash is still present; Vanessa makes a doctor's appointment. Over break, she travels to Florida with her boyfriend. She notices that her skin seems more sensitive to sunlight. And, after spending all day playing sand volleyball at the beach, she notices that the rash is more pronounced and that she is unusually tired.

Vanessa visits her doctor as soon as she returns home. After a quick examination, the doctor believes that Vanessa has discoid eczema because of the disc shaped flaky, red patches. Discoid eczema commonly occurs on the face, can come and go, and is often exacerbated by sun exposure much like Vanessa's rash. The doctor gives Vanessa a steroid cream to reduce inflammation.

A few days later, Vanessa notices that the rash has spread to her scalp and the some patches have become sores and scabbed over. The rash does not itch like eczema, so Vanessa does research and comes to the conclusion that she may have a skin disease called cutaneous lupus. Her rash looks very similar to lupus rashes she sees online.

Vanessa visits the doctor again and tells her about her theory. The doctor agrees and decides to perform a skin biopsy as well as a blood test.

The doctor asks Vanessa about her family history. Vanessa explains that her aunt and cousin have lupus, although Vanessa is not exactly sure what kind. She also tells the doctor that her mother and father smoke, so she has been around smoking all of her life. Her family also has a history of high blood pressure; Vanessa has a high blood pressure of 142.

Chronic Cutaneous Lupus

On her next visit, the doctor tells Vanessa that, although no one test can conclusively prove a person has lupus, Vanessa's biopsy and blood results suggest she has a type of chronic cutaneous lupus called discoid lupus (named for the distinct round, disk-like patches). The doctor refers Vanessa to a dermatologist.

When Vanessa visits her dermatologist, Dr. White, he explains that lupus is an autoimmune disease in which the body's immune system attacks the body's cells. Nobody knows the exact cause of lupus cutaneous flares, but people are born with a predisposition towards the disease. A family history of lupus increases likeliness as well as being African American and female (90% of people diagnosed with lupus are women). The first signs of lupus usually occur between the ages of 15 and 44 years old.

Vanessa tells Dr. White about her rash seeming to be affected by sunlight. Dr. White tells Vanessa that sun exposure often exacerbates lupus rashes because people with lupus are more sensitive to UVA and UVB light. He recommends that Vanessa avoid sun exposure by wearing sunscreen, covering up when outside, and trying to limit overall sun exposure by only spending time outside during the morning and evening. He also advises her to avoid other environmental triggers like smoking and stress.

Dr. White decides to perform his own tests to further his understanding of Vanessa's lupus. Dr. White determines that Vanessa has an overactive immune system and high levels of estrogen. Both are frequent causes of cutaneous lupus. Dr. White explains that her high levels of estrogen could be caused by her high blood pressure. To lower blood pressure, Dr. White urges Vanessa to reduce her sodium and alcohol intake as well as exercising more.

Vanessa tells Dr. White that she has developed some sort of sore in her mouth. Dr. White examines her. The sore is an ulcer that often develops in lupus patients. The ulcers are sometimes oral and sometimes nasal.

Vanessa asks if lupus is contagious. Dr. White clarifies that lupus is not contagious, and that lupus is fairly common. It is estimated that 1.5 million Americans have some form of lupus.

Cutaneous lupus can effect the cells of the epidermis, dermis, and subcutaneous layers of the skin. The rash often does not itch because the cells are so damaged. Furthermore, Dr. White warns Vanessa that hair follicles and melanocytes can be destroyed resulting in permanent hair loss and pigment change or loss.

Dr. White further explains that lupus can damage many parts of the body besides the skin including joints and internal organs like the hear, brain, lungs, and kidneys. He warns Vanessa that 10% of people with discoid lupus later develop lupus in other organ systems, and that Vanessa's cutaneous lupus could be one of the first symptoms of more severe forms of lupus. Dr. White urges Vanessa to consult him immediately if she experiences any flu like symptoms because it could be an indication that the lupus has spread. 10-15% of people with lupus die from a complication of the disease.

There is no outright cure for lupus; the disease is unpredictable, and Dr. White explains that Vanessa will have to deal with flares and remissions of the disease for the rest of her life. However, he gives her a topical corticosteroid to reduce the inflammation of her skin. Corticosteroids mimic the hormones in the body’s adrenal glands. The steroid increases normal body levels of hormones to reduce inflammation.

The great imitator

Credits

lupus.org

americanskin.org

healthline.com

emedicinehealth.com

womenshealth.org

lupusny.org

niams.nih.gov

hopkinslupus.org