ENGLISH      FRANÇAIS



Home / Online screening material / A digital manual for the early diagnosis of oral neoplasia / Lupus erythematosus

  Lupus erythematosus  Search in Medline for Lupus erythematosus   Go back to the list

This is a chronic auto-immune disorder of unknown etiology. Lupus erythematosus is broadly classified into cutaneous (discoid lupus erythematosus) and systemic (systemic lupus erythematosus forms) involving multiple organs. Oral lesions are seen in both conditions. Facial butterfly rashes are typical of lupus, and photosensitivity is a characteristic of this disease. Young women are more commonly affected Plemons JM, Gonzales TS, Burkhart NW (1999). Vesiculobullous diseases of the oral cavity. Periodontol 2000 21: 158-175.. Clinically, oral discoid lesions are characterized by central atrophy, small white keratinized plaques with elevated borders, radiating white striae and telangiectasia  Pindborg JJ, Reichart PA, Smith CJ, van der Waal I, (1997). World Health Organisation International Histological Classification of Tumours.Histological Typing of Cancer and Precancer of the Oral Mucosa. 2 ed. Berlin: Springer.. They are painless and commonly involve the buccal mucosa, lip and palate. In the absence of typical cutaneous and systemic disease it is very difficult to differentiate these lesions from lichen planus and leukoplakiaOrteu CH, Buchanan JA, Hutchison I, Leigh IM, Bull RH (2001). Systemic lupus erythematosus presenting with oral mucosal lesions: easily missed? Br J Dermatol 144: 1219-1223.Warnakulasuriya S, Johnson NW, van dW, I (2007). Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 36: 575-580. . The malignant potential of oral lesions in discoid lupus erythematosus has been reported by several authors, the risk being highest for labial mucosa and the vermilion border  Pindborg JJ, Reichart PA, Smith CJ, van der Waal I, (1997). World Health Organisation International Histological Classification of Tumours.Histological Typing of Cancer and Precancer of the Oral Mucosa. 2 ed. Berlin: Springer.Warnakulasuriya S, Johnson NW, van dW, I (2007). Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 36: 575-580. .
Several agents like Epstein-Barr virus, certain medications and genetic predisposition have been attributed to the development of this disease Plemons JM, Gonzales TS, Burkhart NW (1999). Vesiculobullous diseases of the oral cavity. Periodontol 2000 21: 158-175.Orteu CH, Buchanan JA, Hutchison I, Leigh IM, Bull RH (2001). Systemic lupus erythematosus presenting with oral mucosal lesions: easily missed? Br J Dermatol 144: 1219-1223. . The diagnosis is by serological test for anti-nuclear antibody and through skin biopsy.

Management:

Protective clothing, sunscreen lotion and lip balm are recommended to avoid photosensitivity. Several immunosuppressive agents have been tried in case of systemic disease Plemons JM, Gonzales TS, Burkhart NW (1999). Vesiculobullous diseases of the oral cavity. Periodontol 2000 21: 158-175.Orteu CH, Buchanan JA, Hutchison I, Leigh IM, Bull RH (2001). Systemic lupus erythematosus presenting with oral mucosal lesions: easily missed? Br J Dermatol 144: 1219-1223. . Patients having oral manifestations can be treated with local steroids and are advised to use mild toothpastes and brushes with soft bristles.


ImageLegend
Figures 1: A: Extraoral photograph of a patient with discoid lupus erythematosus. Note the butterfly-shaped rash on the malar area. B: Intraoral photograph of the same patient showing erosive lesions surrounded by radiating white striae on the left buccal mucosa.
Figure 2: Discoid lupus erythematosus: Note the central erosive area surrounded by radiating white striae in the lower labial mucosa.
Figure 3: Discoid lupus erythematous. An erosive lesion with parallel white striae on the lower lip of a patient with discoid lupus erythematous.
Figure 4: Skin lesions of discoid lupus erythematosus.
IARC, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France - Tel: +33 (0)4 72 73 84 85 - Fax: +33 (0)4 72 73 85 75
© IARC 2017 - All Rights Reserved.