No universally recognized classification criteria currently exist for discoid lupus erythematosus (DLE), which has led to problematic heterogeneity in observational and interventional clinical studies across the field.
Classification Criteria
Development of classification criteria specific for the diagnosis of DLE was initiated by experts using a Delphi method in 2017. While validation of these criteria is required, they provide a preliminary diagnostic classification scheme to be used clinically and for research. The 12 characteristics, stratified by category, include the following:
Morphology:
- Erythematous-violaceous in color
- Atrophic scarring
- Dyspigmentation
- Follicular hyperkeratosis/plugging
- Scarring alopecia
Histopathology:
- Interface/vacuolar dermatitis
- Perivascular and/or periappendageal lymphohistiocytic infiltrate
- Follicular keratin plugs
- Mucin deposition
- Basement membrane thickening
Location:
- Location in conchal bowl
- Preference for head and neck
Final Model for DLE Classification Criteria
| Clinical feature | Points assigned |
| Atrophic scarring | 3 |
| Location in the conchal bowl | 2 |
| Preference for head and neck | 2 |
| Dyspigmentation | 1 |
| Follicular hyperkeratosis/plugging | 1 |
| Erythematous to violaceous in color | 1 |
A score of 5 points yields classification as DLE with 84.1% sensitivity and 75.9% specificity. A score of 7 points yields 73.9% sensitivity and 92.9% specificity.
References:
- Elman SA, Joyce C, Braudis K, Chong BF, Fernandez AP, Furukawa F, Hasegawa M, Kim HJ, Li SJ, Lian CG, Szepietowski JC, Werth VP, Merola JF. Creation and Validation of Classification Criteria for Discoid Lupus Erythematosus. JAMA Dermatol. 2020 Aug 1;156(8):901-906. [Medline]
- Elman SA, Joyce C, Nyberg F, Furukawa F, Goodfield M, Hasegawa M, Marinovic B, Szepietowski JC, Dutz J, Werth VP, Merola JF. Development of classification criteria for discoid lupus erythematosus: Results of a Delphi exercise. J Am Acad Dermatol. 2017 Aug;77(2):261-267. [Medline]
Created Nov 18, 2020.
