More rarely, the lesions may be bright red and look like hives. Location of lesions
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  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.More rarely, patients may have lesions on the head and neck as well as the arms and trunk. Special characteristics of some lesions
Scalp lesions
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. The lesions often lose skin pigment and become white with areas of increased skin pigment, with or without areas of redness, and have a sunken appearance. They can have a smooth surface or have visible, dilated hair follicles on the surface. Lip lesions
When discoid lupus is on the lip, it often has a grey or red colour with a thickened top layer of skin (known as hyperkeratosis), areas where the top layer has worn away (known as erosion), and a surrounding rim of redness. Other symptoms
Patients may state that their lesions are itchy, tender, or asymptomatic. In addition to their skin lesions, they may also have swelling and redness around their eyes, as well as blepharitis. Complications
Darker-skinned patients are often left with severe scarring and skin color changes even after the lesions get better.
In addition to lesions in the typical above-the-neck locations, patients with generalized discoid lupus often have lesions on the thorax and the arms. These patients are often bald, with abnormal skin pigment on their scalp, and have severe scarring of the face and arms. Patients with generalized discoid lupus often have abnormal lab tests, such as an elevated ESR or a low white blood cell count. They also often have auto-antibodies, such as ANA or anti-ssDNA antibody. Childhood
When patients develop discoid lupus in childhood, it differs from typical discoid lupus in several ways. Boys and girls are equally affected, and these patients later develop SLE more often. These patients also typically do not have any abnormal sensitivity to the sun. Special types of discoid lupus lesions
Hypertrophic lupus
Some experts consider hypertrophic lupus erythematosus—which consists of lesions covered by a very thick, keratin-filled scale—an unusual subset of discoid lupus. Others consider it a distinct entity. Lupus profundus
If a patient has discoid lupus lesions on top of lupus panniculitis, they have lupus profundus. These patients have firm, nontender nodules with defined borders underneath their discoid lupus lesions. Systemic lupus erythematosus with discoid lupus lesions
In general, patients with discoid lupus who have only skin disease and no systemic symptoms have a genetically distinct disease from patients with SLE. However, 25% of patients with SLE get discoid lupus lesions at some point as part of their disease.