Does Discoid Lupus Erythematosus Cause Itching?
Yes, discoid lupus erythematosus (DLE) commonly causes itching, with pruritus present in approximately 77% of patients with active cutaneous lupus lesions. 1
Prevalence and Characteristics of Itch in DLE
Pruritus occurs in 76.8% of patients with active DLE lesions, and approximately half of these patients experience moderate to severe itching (scoring ≥4 on the Numeric Rating Scale) 1
The intensity of itching directly correlates with disease activity (r = 0.42, p = 0.0001), meaning more active skin lesions produce more severe pruritus 1
More than half of patients experience daily itching, with symptoms most frequently occurring during evening hours 1
Quality of Itch Sensation
The itch in DLE has distinctive characteristics that differ from simple pruritus:
Most commonly described as burning, tingling, or an "ants crawling" sensation rather than pure itch 1
Only 31.9% of patients describe the sensation as "pure itch," while the majority experience these atypical sensory qualities 1
The itch is most frequently localized to the scalp (40.5%), face excluding ears and nose (36.2%), and arms (31.9%) 1
Clinical Significance
Pruritus intensity correlates with both cutaneous lupus activity and systemic lupus erythematosus (SLE) activity, suggesting it serves as an individual indicator of disease severity 1
There is no correlation between itch intensity and skin damage scores (CLASI damage score, p = 0.16), indicating that pruritus reflects active inflammation rather than scarring 1
Important Distinction from Other Conditions
This differs markedly from lichen sclerosus, where itch is the main symptom in female patients (often severe enough to disturb sleep) 2, but itch is not a prominent symptom in male genital lichen sclerosus 2. When evaluating ear canal involvement, DLE should be distinguished from seborrheic dermatitis, which presents with greasy yellowish scaling and itching 2.
Clinical Pitfall
Pruritus in DLE is frequently overlooked despite being a common and distressing symptom 1. Failure to assess and address itching can significantly impact quality of life and may indicate inadequately controlled disease activity requiring treatment adjustment 1.