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Lupus erythematosus  

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 . Clinically, oral discoid lesions are characterized by central atrophy, small white keratinized plaques with elevated borders, radiating white striae and telangiectasia . 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 leukoplakia . 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 .
Several agents like Epstein-Barr virus, certain medications and genetic predisposition have been attributed to the development of this disease . 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 . Patients having oral manifestations can be treated with local steroids and are advised to use mild toothpastes and brushes with soft bristles.

Image	Caption
	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.