Lupus Erythematosus is a kind of a disease that is persistent and chronic besides it causes the infected individual to have inflammation on various parts of his/her body. Lupus as it is commonly known can be mild or severe and it is a systemic kind of a disease. There are two types of the disease namely; discoid lupus that only affects the skin and systemic lupus erythematosus (SLE), which affects mainly the joints, skin and even internal organs like liver , even brain and heart, (Tyndall, A.,2011)
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Systemic lupus erythematosus, as it is commonly referred to, is a kind of a disease that results from the immune system of the body “attacking itself”; it is an autoimmune kind of an ailment. Autoimmunity arises when the body’s disease protecting system mistakenly attacks itself. SLE is mainly prevalent in women than men, having ages between 20 – 40 years, however that does not mean it is age restrictive, it can affect anybody of any age. Although this condition can run in families, studies show that 3 in every 100 children in families having Systemic lupus erythematosus may actually develop the condition. This disease is common with African Americans and the people in Asia. It is believed to result from interplay of a number of factors including genetic, environmental and hormonal interaction with the body antibodies, (Lahita , R. G., 2011).
Discoid Lupus Erythematosus (DLE) is actually a mild or benign form of SLE, (Isenberg, D., & Manzi, S. ,2008), which involves body organs like skin and in particular the face. Patients who have DLE may develop SLE in its later stages, though a small percentage of DLE patients actually develop SLE.
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Discoid Lupus Erythematosus is a severe and chronic skin disease causing dermatological destruction as loss in hair, scarring and if not treated at it early stages it may lead to hyper pigmentation of the skin. DLE usually manifestation of SLE that shows itself in form of plaques and papules with scales, these skin eruptions are usually photosensitive and they can be within a specific area of the skin or just widespread, (Bourgeois, S., 2008).
Causes and Symptoms of Lupus Erythematosus
As pointed out earlier above, SLE is autoimmune disease whereby the immune system of the body tries to attack its self. This presents a unique and complicated situation whereby the mechanism that is supposed to protect the body instead attacks itself, though many research has been done and studies continue, its underlying causes remain largely unknown. However, some research done show that SLE may actually be caused by certain drugs, hereditary genes, and exposure to ultra violet light among other causes.
SLE exhibit a variation in symptoms in the affected individuals, but the common of the symptoms is pain in the joints where some patients may end up to developing arthritis. The symptoms may appear and go. Although, there is variation in symptoms and severity in SLE, generally the patients exhibit a loss in weight and slight fever, (Callen, J., 2011) The other most prevalent symptoms include, pains in joints and muscles, this mainly affects the small joints of the hands and feet meaning, less major joints are affected. Although swellings usually occur in the joints, the damage and arthritis is normally not severe with this disease.
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The other major symptoms of Lupus include rashes that are shaped like butterflies mostly in the cheeks, oval patched rashes and general rushes on parts exposed to the sun. In addition, it manifests itself in form of sores in the mouth, inflammation of the heart or the lungs, also kidney problems are normally apparent with this kind of disease. Apart from the above symptoms, there is general drop in blood cells count, as well as neurological problems.
Lupus Erythematosus Treatment and Medication
There is no well-documented or known cure for LUPUS; however, it is advisable to prevent its symptoms than cure. Such type of treatment is symptoms dependent, (Urowitz , M. B., 2005). The seriousness and extend of the infection is also key in determining how better to handle the ailment.
At its early stage, a number of treatment methods can be employed, for instance, to treat symptoms of joints and pleurisy, NSAIDS is normally used, whereas skin rashes can be treated with creams, specifically Corticosteroid creams. Antimalarial drugs together with corticosteroids of low doses have also been used to treat arthritis and skin symptoms.
It should be noted that severely levels of LUPUS comes with great psychological impact to those whore suffer from the disease, (Wallace, D. J. ,2002). however, its treatment include; decreasing of immune system response by using high-dose corticosteroids, similarly drugs that block cell growth have proved to be effective, for instance cytotoxic. However, these drugs can have severe side effects on the patient and need to be monitored closely.
A number of drugs have proved successful in the treatment of LUPUS at its chronic or more severe form. The following are the drugs that can be used to manage the disease;
- Topical Corticosteroids: Form the mainstay of treating Discoid Lupus Erythematosus, the patients on this medication start with a potent steroid that has to be applied two times a day after which a switch is as soon as possible to a lower potent steroid. The use of less steroids help reduce the side effects, that are normally recognizable for instance atrophy, purpura and striae.
- Intralesional Steroids: These types of steroids are normally used in treatment of lesions that are chronic. Intralesional steroids are normally associated with cutaneous atrophy as well as dyspigmentation, as its major side effects, though these side effects pose no problems and can easily be handled by experienced medical staff. In the case non-responsive patients, systemic oral agents may be used.
- Antimalarials: this type of therapy forms first-line treatment for DLE, it can be administered in combination or just singly. Three types of preparations are mostly used which include chloroquine, Mepacrine and hydroxychloroquine. Mepacrine, however, is commercially restricted in some countries like US. Normally the patient has to start with 200mg of hydroxychloroquine per day, for a grown up, and if no side effects for example gastrointestinal ,the dosage is then increased to two times per day.
It should be observed that any clinical improvement can be observed after 4-8 weeks of medication; therefore, patients should be advised accordingly. It is worth noting, however, that dosage be strictly be kept below 6.5g/kg/day and if the patient does not show any response, chloroquine should be administered as this maybe more effective. In some circumstances, patients may not be responsive to either of the above drugs and as such Mepacrine is advisable as an alternative. Other drugs used in the treatment of DLE include Methotrexate, CyclosporinA, Tacrolimus, Mycophenolate mofetil and Azathioprine.
General Measures and Management of Lupus Erythematosus
LUPUS has no treatment; the available measures can be so expensive and will incur considerable expenditures to facilities and individuals. However, its management is less costly and has proven to be successful.
The lesions, which are usually cutaneous, in individuals affected by Lupus are known to be made worse with exposure to ultraviolet light, an approach to manage discoid lupus involves avoiding of direct sun and the application of sunscreens to shield the person suffering, from the ultraviolet light. It is advisable also to educate the patients on the need to apply sunscreens and avoid direct sunlight especially between 10 AM – 4 PM, (Wallace, D. J., 2000). Care should also be taken against exposure to ultraviolet light that results from reflection from snow hence such places should be avoided, if the patient has had great exposure to light they should apply themselves sunscreen or when they are wet. To sum it up, one needs to be active by having exercises and get to involve him or herself in personal care.
Conclusion
Lupus is an autoimmune disease, which can develop to its chronic form of Discoid Lupus Erythematosus, and as such early treatment is necessary. In its chronic stage, it has far much worse effects as it may lead to hair lose and disfiguring of the face as well as permanent scaring. Treatment of chronic form of Lupus can also be so costly and as such proper management of the disease need to done at early stage.
There are several forms of treatment that are effective to a lesser or greater degree than others. There are too few properly conducted randomized trials to enable an informed choice by clinicians. Clinicians at the present time are, therefore, likely to choose their preferred treatment based on their own experience. There is a need for further large randomized, controlled, and possibly multinational trials to be conducted that compare the effectiveness and safety of one form of treatment compared with another.
Early effective treatment may lead to total clearing of skin lesions, but failure of treatment results in permanent scarring; the depressed scars, hair loss, and pigmentary changes are often extremely disfiguring, particularly in darker-skinned people. The treatment of Discoid Lupus Erythematosus would in most instances be initiated at a dermatology department, but before instituting treatment for discoid lupus patients should be assessed for systemic involvement. This should include a full history and physical examination, full blood count, erythrocyte sedimentation.
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