7809 - Discoid lupus erythematosus

DBQ: Link to Index of DBQ/Exams by Disability for DC 7809 

Acronym: LE

Definition

Discoid lupus erythematosus (DLE) is a chronic and recurrent disease of the skin (see diagnostic code: 6305 lymphatic filariasis).

Etiology

The cause of the disease is unknown. It is thought to be an autoimmune disorder, and is most often limited to the skin. It may also eventually develop into systemic lupus erythematosus (see diagnostic code: 6350 lupus erythematosus, systemic [SLE]). The disease occurs most often in females in their thirties; however, the condition may occur at any age.

Signs & Symptoms

The condition is characterized by remissions and exacerbations of circumscribed scaling, red lesions in the form of macules, plaques, or a rash. The lesions have plugged follicles, telangiectasis, and are atrophic. The lesions usually occur on the cheeks, bridge of the nose, and scalp. A classic finding in DLE is the involvement of the external ear to include the outer portion of the external auditory canal. The lesions may appear on the upper portion of the trunk and extensor surfaces of the extremities. The lesions cluster on sunlight-exposed areas of the skin. There also may be lesions in the mouth. Alopecia may occur; it may be permanent with scars. Sixty-percent of the patients with DLE have scalp involvement. One-third of DLE patients with scalp involvement often develop an irreversible scarring alopecia. There may be varying degrees of systemic involvement if, when untreated, the disease gradually extends peripherally.

Tests

Diagnostic tests include: biopsy from an active lesion, complete blood count (CBC), erythrocyte sedimentation rate (ESR), tests for antinuclear factors, and renal function studies.

Treatment

The lesions may be treated with antimalarial drugs and topical corticosteroids. However, overuse of corticosteroids should be avoided. Plastic tape coated with corticosteroids may be used with resistant lesions. The person should avoid exposure to sun.

Residuals

Residuals may include lesions that persist or reoccur for years. Long-term drug therapy may be required. Atrophy may be permanent. The person should avoid exposure to sun.

Special Considerations

Consider service connection on a presumptive basis as a chronic condition (38 CFR §3.307; §3.309(a)).

Notes

  • Do not combine with ratings under DC 6350.
  • 38 CFR 4.118 (a) For the purposes of this section, systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin.  

  • 38 CFR 4.118 (b) Two or more skin conditions may be combined in accordance with 38 CFR 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used.