[1][2] It presents with red, painful, inflamed and coin-shaped patches of skin with a scaly and crusty appearance, most often on the scalp, cheeks, and ears.

[3] The lesions can then develop severe scarring, and the centre areas may appear lighter in color with a rim darker than the normal skin.

[3] The skin lesions are most often in sun-exposed areas localized above the neck, with favored sites being the scalp, bridge of the nose, upper cheeks, lower lip, and ear and hands [3][5] 24% of patients also have lesions in the mouth (most often the palate), nose, eye, or vulva, which are all mucosal parts of the body.

[3] When discoid lupus is on the scalp, it starts as a red flat or raised area of skin that then loses hair and develops extensive scarring.

[5] In addition, these patients have an increased, though still small, risk for aggressive skin squamous cell carcinoma.

[5] Most experts consider DLE an autoimmune disease since pathologists see antibodies when they biopsy the lesions and look at the tissue under the microscope.

[5] This material diffuses to the dermoepidermal junction, where it binds to circulating antibodies, thereby leading to a series of inflammatory reactions by the immune system.

[3] If the patients do indeed have discoid lupus, the doctor may see tiny spines of keratin that look like carpet tacks and are called langue au chat.

[5] Typical biopsy findings include deposits of IgG and IgM antibodies at the dermoepidermal junction on direct immunofluorescence.

[3][5] The epidermis appears thin and has effaced rete ridges as well as excess amounts of keratin clogging the openings of the follicles.

[3] The differential diagnosis includes actinic keratoses, sebborheic dermatitis, lupus vulgaris, sarcoidosis, drug rash, Bowen's disease, lichen planus, tertiary syphilis, polymorphous light eruption, lymphocytic infiltration, psoriasis, and systemic lupus erythematosus.

[3] These patients are often bald, with abnormal skin pigment on their scalp, and have severe scarring of the face and arms.

[3] Patients with generalized discoid lupus often have abnormal lab tests, such as an elevated ESR or a low white blood cell count.

[4] These patients have firm, nontender nodules with defined borders underneath their discoid lupus lesions.

[10] Discoid lupus erythematosus is a chronic condition, and lesions will last for several years without treatment.

[11] Singer Michael Jackson was reportedly diagnosed with discoid lupus in 1984; the condition might have damaged his nasal cartilage and led to some of his cosmetic surgery.