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Updated: Jan 29, 2026
Dermoscopy Aids in the Diagnosis of Discoid Lupus Erythematosus
Published on: May 16, 2025
Practice-based differences in paediatric discoid lupus erythematosus
L M Arkin1, K Buhr2, H Brandling-Bennett1
1Department of Dermatology and Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A.
Insights
Pediatric dermatologists and rheumatologists show significant differences in treating childhood discoid lupus erythematosus (DLE). There is a lack of consensus on optimal screening and treatment for DLE, impacting patient care.
Area of Science:
- Pediatric Rheumatology
- Pediatric Dermatology
- Autoimmune Diseases
Background:
- Childhood discoid lupus erythematosus (DLE) poses risks of disfigurement and progression to systemic lupus erythematosus (SLE).
- Optimal management strategies for pediatric DLE lack established consensus.
- Understanding current practice patterns is crucial for improving care.
Purpose of the Study:
- To compare the clinical practice patterns of pediatric dermatologists and rheumatologists managing pediatric DLE.
- To identify areas of consensus and divergence in the treatment approaches for pediatric DLE.
Main Methods:
- An online survey was distributed to pediatric rheumatologists (n=292) and dermatologists (n=200).
- Consensus was defined as agreement among at least 70% of respondents.
- Response rates were 38% for dermatology and 21% for rheumatology.
Main Results:
- Both specialties agreed on essential screening laboratory tests, including CBC, urinalysis, complement levels, ESR, autoantibodies, and liver/renal function tests.
- Agreement was reached that arthritis or nephritis warrants intensified SLE evaluation.
- Consensus was achieved for hydroxychloroquine as first-line therapy, but not for subsequent treatment lines.
Conclusions:
- Significant practice variations exist between pediatric dermatologists and rheumatologists in managing DLE.
- Key knowledge gaps were identified concerning SLE risk factors, optimal screening protocols, and treatment for refractory skin disease.
- Further research and guideline development are needed to standardize pediatric DLE care.
Background:
Children with discoid lupus erythematosus (DLE) are at risk for disfigurement and progression to systemic lupus erythematosus (SLE). Consensus is lacking regarding optimal care for children with DLE.
Objectives:
The aim of this study was to compare practice patterns among paediatric dermatologists/rheumatologists treating paediatric DLE.
Methods:
An online survey was sent to 292 paediatric rheumatologists in the Childhood Arthritis and Rheumatology Research Alliance and 200 paediatric dermatologists in the Pediatric Dermatology Research Alliance. Consensus was defined as ≥ 70% agreement.
Results:
Survey response rates were 38% (76 of 200) for dermatology and 21% (60 of 292) for rheumatology. Both specialties agreed that screening labs should include complete blood counts with differential, urinalysis, complement levels, erythrocyte sedimentation rate, antinuclear antibody and other autoantibodies, hepatic function and renal function/electrolytes. Both specialties agreed that arthritis or nephritis should prompt intensified evaluation for SLE. No other patient features achieved consensus as disease-modifying risk factors. Hydroxychloroquine was agreed upon as first-line systemic therapy, but consensus was lacking for second- or third-line treatment.
Conclusions:
We found few areas of consensus and significant practice differences between paediatric dermatologists and rheumatologists treating DLE. Knowledge gaps include risk factors for SLE, optimal screening and treatment of refractory skin disease.
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