Discoid Lupus Erythematosus

Discoid lupus accounts for 30-40% of scarring alopecia cases, with fewer than 10% of patients progressing to systemic lupus erythematosus. Patients with discoid lupus present with red plaques of hair loss, atrophy, telangiectasias, and follicular hyperkeratosis. Scalp lesions begin as red papules or irregular small scaly plaques that later merge into swollen, red plaques. At this stage, hair loss may still be reversible. The thickened scale that develops can be removed to reveal keratinous plugs representing follicular hyperkeratosis, distinguishing it from lichen planopilaris, which has hyperkeratosis towards the periphery. As the lesion expands, the central redness fades, and the surface flattens, revealing loss of skin color, atrophy, and scarring.