Discoid lupus is one of the easiest forms of cutaneous lupus to recognize. It is most commonly found on the head and neck region and has a tendency to be present within the conchal bowl of the ear. Lesions are often found in patients with SLE. Discoid lupus may occur as an entirely separate disease with no other systemic or clinical findings of lupus. Fewer than 10% of these patients eventually progress to the systemic form of lupus. Discoid lesions are exacerbated by sun exposure, more specifically by exposure to ultraviolet A (UVA) light. The lesions tend to have an annular configuration with varying amounts of scale. The lesions can produce alopecia, and there is almost always some amount of atrophy present. Follicular plugging is commonly seen in discoid lupus. It is noticed clinically as a dilation of the follicular orifices. Follicle plugs can also be seen by gently removing the scale from a discoid lesion. On close inspection of the inferior side of the scale, one will notice minute keratotic follicular plugs. This finding is specific for discoid lupus and has been termed the “carpet tack sign,” because it resembles tiny outreaching tacks. This sign can be easily missed if the scale is removed too quickly or not inspected closely enough. Discoid lesions in darker-skinned individuals may also have varying amounts of hyperpigmentation. Most patients have some erythema and hyperpigmentation. Most patients present with a few discoid lesions and are said to have localized discoid lupus. Those rare patients with widespread disease have generalized discoid lupus. This variant is rare, and such patients are much more likely than those with localized disease to go on to fulfill the criteria for SLE at some point. The alopecia seen in discoid lupus is scarring in nature, and the hair that has been lost will not regrow even with aggressive therapy. Alopecia can be life-altering and can cause significant psychological morbidity.

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