Discoid Lupus Disease

"Revealing the Complexities of Discoid Lupus: Navigating Symptoms, Diagnosis, and Treatment Paths"

In the ever-evolving landscape of healthcare, where advancements in research and technology continue to reshape the way we approach medical conditions, it is crucial to cast a focused lens on diseases that often remain veiled in mystery.

 Discoid Lupus, a variant of the autoimmune disease Lupus Erythematosus, stands as one such enigmatic condition that demands both clinical and market-oriented exploration.

National institute of Health (NIH) states that, all age groups are susceptible to lupus, although women in their fourth and fifth decades of life are more likely to develop DLE. At some time during their illness, 25% of people with SLE develop classic discoid lesions, while 1% to 5% of patients with discoid lupus develop SLE.

Another significant risk factor for LE is ethnicity, which in certain groups has an impact that is nearly as great as gender. African American women have a four-fold higher prevalence of SLE (4 in 1000 versus 1 in 1000) than White women. African Americans also have a greater death rate and a tendency for the disease to strike them sooner in life.

Discoid Lupus erythematosus (DLE) is a skin disease that causes chronic scarring. This is cutaneous lupus' most prevalent variant.

Chronic cutaneous lupus erythematosus has a subtype known as DLE. Permanent scaly plaques on the face, ears, and scalp are its defining feature. This leads to permanent hair loss in the affected areas, as well as scarring, atrophy, and dyspigmentation.

Although the exact etiology of DLE is unknown, an autoimmune disease is believed to be the culprit. Everybody has an immune system that produces the necessary antibodies to fend against illnesses. These antibodies typically don't target own tissues. But in an autoimmune disease, our immune system misfires, attacking our own body instead of the enemy. The immune system misidentifies the cells in skin as "foreign," leading to the production of damaging antibodies in DLE.  Females are more likely than males to get the illness.  It also affects patients from specific ethnic groups more frequently.

DLE has both external and endogenous causes.

Among the endogenous factors are:

• Major Histocompatibility Complex alleles HLA-DQA1 and DRB1 indicate a genetic susceptibility.
• TYK2, IRF5, and CTLA4 single nucleotide polymorphisms are also connected.
• Type 1 interferon is an important cytokine in pathogenesis.
• Interferon control involves IRF5 and TYK2.
• More people with DLE are at risk for ITGAM polymorphisms than from systemic lupus erythematosus (SLE).

Among the exogenous factors are:

• Smoking reduces the effectiveness of antimalarial medications and is more prevalent in DLE patients.
• Since DLE is a photosensitive disorder, ultraviolet radiation causes it. But it's located in places that aren't exposed to the sun.

Sign & Symptoms

DLE is classified as either localized (occurs above the neck in 80% of cases) or generalized (20% of cases occurs both above and below the neck). The rash is painful and irritating, yet it is frequently asymptomatic. The majority of DLE patients simply experience skin involvement, however others already have SLE symptoms or later develop them. The lesions usually change over time.

A few typical indications of localized DLE are:

From first dry red patches, adhering scale-covered crimson plaques develop. It is typical to have follicular hyperkeratosis, or keratin plugs inside hair follicles. The horny plugs become visible when this scale is removed with adhesive tape, resulting in the "carpet-tack" symbol.

Atrophic scarring and scarring alopecia are prevalent as DLE worsens. This is linked to hyper- or hypo-pigmentary changes, and people with darker skin tend to notice it more.

Typically, DLE is found on the conchal bowl (Shuster sign), ear lobes, cheekbones, and nose. It affects the nose, eyes, lips, or oral mucosa.

Symptoms of generalized DLE consist of:

Although the lesions' morphology is like that of the face and scalp, they are more broadly dispersed, occurring most frequently on the dorsum of the hands, anterior chest, upper back, and less frequently on the lower limbs, palms, and soles. Anogenital mucosa involvement occurs infrequently.

Differential Diagnosis:

Some other disease conditions have the same symptoms as Discoid Lupus. This disease includes:

• Lichen planus
• Actinic keratoses
• Polymorphous light eruption (PMLE)
• Drug-induced lupus erythematosus
• Chilblain lupus erythematosus
• Systemic lupus erythematosus
• Squamous cell carcinoma

Diagnostic Analysis

The distribution and clinical features of discoid lupus erythematosus plaques are used to identify the condition. A comprehensive evaluation is necessary to rule out further lupus symptoms in a patient with DLE.

Laboratory Test

• A complete blood count (CBC): This test counts the amount of hemoglobin, a protein found in red blood cells, as well as the number of white blood cells, platelets, and red blood cells.
• Erythrocyte sedimentation rate(ESR): The pace at which red blood cells sink to the bottom of a tube in an hour is discovered by this blood test. A systemic condition like lupus is indicated by a faster than normal pace.
• Urinalysis: If renal function has been compromised by lupus, a urine sample analysis will reveal elevated protein levels or red blood cells.
• Antinuclear antibody (ANA) test: A positive result denotes an immune system that has been aroused because these antibodies are produced by the immune system. Antinuclear antibody (ANA) tests are positive in most cases in patients with lupus, but not in most cases in those who do not. The doctor will recommend more focused antibody testing if the ANA test is positive.

Skin Biopsy

To confirm the clinical diagnosis of DLE, a skin biopsy is necessary. An active lesion biopsy facilitates the identification of:

• A perivascular and peri-appendageal lymphocytic infiltration in the upper and lower dermis, as well as an interface dermatitis involving hair follicles, are among the features that vary depending on the stage of DLE.
• Hyperkeratosis, apoptotic basal cells, and epidermal vacuolation are present.
• Dermal mucin is present, and the basement membrane is thickened.
• Dermal fibrosis develops as lesions progress and the inflammatory infiltrate decreases.

Treatment Analysis

As DLE is an autoimmune disease that leaves scars and worsen over time, it should come as no surprise that it has a significant psychological toll. As a result, there is a need for therapy, which is frequently prolonged and expensive for medical facilities.

Early, successful therapy completely removes skin lesions; nevertheless, treatment failure leaves behind lasting scars, which is very disfiguring, especially for those with darker skin. These scars include depression scars, hair loss, and pigmentary changes.

General Measures

• cautious year-round sun protection with clothing and liberal application of broad-spectrum, high SPF sunscreens. Sunscreens by themselves are insufficient.
• Certain patients also need to avoid glass windows when indoors, or they are able to be covered with UV-blocking coatings.
• For people who avoid the sun at all costs, vitamin D pills ought to be suggested.
• Quitting smoking.

 Medication

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are over-the-counter medications that are used to treat the pain, swelling, and fever associated with lupus. Examples of these medications are ibuprofen (Advil, Motrin IB, and others) and naproxen sodium (Aleve). Prescriptions are available for stronger NSAIDs. Stomach bleeding, kidney issues, and an elevated risk of heart problems are among the side effects of NSAIDs.

Antimalarial Medications: Drugs like hydroxychloroquine (Plaquenil), which are frequently used to treat malaria, have an impact on the immune system and reduce the chance of lupus flare-ups. Retinal damage is an extremely unusual side effect, as is an unsettled stomach. It is advised to get regular eye exams when taking these drugs.

Corticosteroids: Prednisone and other corticosteroid medications reduce lupus-related inflammation. Steroids at high dosages, including methylprednisolone (Medrol), are frequently used to treat severe renal and brain diseases. Weight gain, bruising easily, thinning bones, high blood pressure, diabetes, and an elevated risk of infection are some of the side effects. larger dosages and longer treatment regimens carry a larger risk of adverse effects.

Immunosuppressants: In severe lupus instances, medications that weaken the immune system are beneficial. Leflunomide (Arava), Methotrexate (Trexall, Xatmep, etc.), Azathioprine (Imuran, Azasan), Mycophenolate (Cellcept), and Cyclosporine (Sandimmune, Neoral, Gengraf) are a few examples. An increased risk of infection, liver damage, lower fertility, and an increased risk of cancer are possible side effects.

Laser Therapy

Those who suffer from any of the following conditions benefit from laser therapy:

• thick discoid lupus patches that don't go away after treatment.
• Hyperpigmentation is the term for dark areas that frequently develop on darker skin tones because of lupus rashes, elevated patches, or open sores.
• scarring brought on by discoid lupus or acute cutaneous lupus.

Regulatory Framework

In 2020, The FDA is concerned about the inappropriate use of Chloroquine and Hydroxychloroquine to treat or prevent coronavirus illness (COVID-19) in non-hospitalized patients.

The FDA has approved the use of hydroxychloroquine to treat autoimmune diseases like rheumatoid arthritis, systemic lupus erythematosus in adults, and chronic discoid lupus erythematosus. Instead of obtaining regular FDA approval, the EUA allowed the FDA to approve their limited-time, temporary usage during the COVID-19 epidemic.

Furthermore, due to a shortage of another medication or for public health reasons, TGA approved Medsurge Healthcare Pty Ltd's CELESTONE SOLUSPAN (Injectable 30mg/5mL Suspension, USP) for import and supply in Australia until May 31, 2024.

Clinical Trail Assessment

DiseaseLandscape Insights consultancy firm provides valuable support in future market trends on the development of new pharmaceutical products. This support helps to streamline the planning and execution of clinical trials of novel medications and treatments, implement effective patient recruitment strategies, ensure regulatory compliance, and increase the likelihood of successful trial outcomes.

The below table gives information about some currently ongoing clinical trials, including their study titles and respective stages:

Conclusion

DiseaseLandscape Insights (DLI) helps companies build and run effective strategies to prevent and control Discoid Lupus epidemics. Furthermore, as awareness and anticipated epidemics grow, there is a growing demand for diagnostic tools, clinical evaluations, and novel therapeutics.

DLI helps with target market identification, marketing strategy development, and informing industry participants about new trends. Healthcare organizations gain a competitive advantage, improve patient outcomes, and make a positive impact on global healthcare standards by leveraging DLI expertise.

This incentivizes multinational corporations to conduct research in the areas of Discoid Lupus diagnosis and treatment, as well as legal compliance among manufacturers. Overall, DLI services aid in the establishment of a stronger foothold for all market participants.