Clinical Presentation of Discoid Lupus Erythematosus May Be Attributed to Racial Differences

Doctor comforting patient in office
Researchers identified the characteristics and distribution of discoid lupus erythematosus skin lesions among Black vs non-Black patients.

Disease damage, including ear dyspigmentation, scalp dyspigmentation, and scarring alopecia, were observed to be more frequent among Black patients with discoid lupus erythematous (DLE), according to study results published in Lupus Science & Medicine.

Discoid cutaneous erythematosus is a form of chronic cutaneous lupus erythematous that is more frequently observed among Black individuals. The condition is commonly characterized by scaly plaques, dyspigmentation, and scarring around the scalp, ears, and cheeks. However, racial and ethnic differences in clinical presentation of DLE that affect disease outcomes are not well understood. 

To understand the differences in DLE lesion distribution and characteristics among Black vs non-Black individuals and to help clinicians better provide recommendations, researchers conducted a retrospective cohort study with 112 Black patients and 71 non-Black patients from the University of Texas Southwestern. Adult patients with DLE reported race and ethnicity and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) scores, a validated instrument that measures severity of disease activity and disease damage. Disease activity characteristics included erythema, scale/hyperkeratosis, mucous membrane involvement and nonscarring hair loss. Disease damage components included dyspigmentation, scarring, and scarring hair loss.

Multivariable logistic regression revealed increased odds of scalp (odds ratio [OR], 2.54; 95% CI, 1.20-5.37; P =.015) and ear (OR, 1.97; 95% CI, 1.06-3.68; P =.032) involvement in Black patients compared with non-Black patients. Black vs non-Black patients also had greater odds of having dyspigmentation at any anatomic location (P <.001), ear dyspigmentation (P =.001), scalp dyspigmentation (P <.001) and scalp scarring (P =.001). Overall, Black vs non-Black patients with DLE had worse baseline CLASI damage scores (median, 10.0 vs 6.0, respectively; P <.001)

Researchers suggested that cultural hair care practices among Black patients may contribute to more frequent and severe scarring alopecia. In addition, Black patients with DLE may develop skin damage of the scalp and ear more commonly than non-Black patients, despite both groups having similar disease activity and follow-up duration in the study.

Researchers advised that Black patients with DLE should be examined for scalp and ear involvement at the initiation of treatment. Previous studies have shown that Black patients perceived clinicians to have a lack of understanding and discomfort with Black individuals’ skin and hair, which was found to be a barrier for Black patients in seeking and receiving treatment. Therefore, the researchers of the current study recommended that providers educate themselves on common hair care practices, such as cosmetic camouflage or tightly coiled hair, to refine their recommendations to Black patients with DLE.

The study was limited by the single-center design and small sample size. However, the researchers noted that the racial diversity of the cohort was consistent with that of other epidemiologic studies of DLE.

“Recognizing differences in clinical presentation of DLE in Black patients can assist future efforts with understanding biological, cultural, psychosocial and systemic factors that influence DLE presentation and outcomes in Black patients,” the researchers concluded.

Disclosure: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Joseph AK, Windsor B, Hynan LS, et al. Discoid lupus erythematosus skin lesion distribution and characteristics in Black patients: a retrospective cohort study. Lupus Sci Med. 2021;8:e000514. doi:10.1136/lupus-2021-000514