Blistering Mucosal Eruption in a Young Woman With Systemic Lupus Erythematosus —Quiz Case

Association between oral lesions and disease activity in lupus erythematosus

“…[1][2][3][4][5][6][7][8][9][10][12][13][14][15][16][17][18][19][20][21][22][23] The relationship of oral lesions to systemic disease is controversial, but some studies agree that oral mucosal lupus is associated with increased physician-reported systemic disease activity. 25,30,40 To date, oral ulcers have not been associated with nephritis, 24,25 with vasculitis 24,25,40 or with a significant change in serum levels of anti-dsDNA antibodies, ANA or complement. Oral ulcers in the setting of SLE have long been considered to be predictors of systemic vasculitis and worse prognosis.…”

“…24,25,28,32 Attempts have been made to correlate oral manifestations with the prognosis of SLE, but conclusions vary. 24,25 Nonetheless, oral ulcers are included in the following activity indexes of SLE: British Isles Lupus Assessment Group, 41 SLEDAI, 38 Safety of Estrogens in Lupus Erythematosus National Assessment-SLEDAI, systemic lupus activity measure 31 and European Consensus Lupus Activity Measurement. 39 However, three previous studies found that oral ulcers in patients with SLE represent, in fact, specific lupus lesions clinically and histopathologically (interface mucositis) without evidence of vasculitis.…”

“…4,9,10,12,13,17,18,[20][21][22][24][25][26][27][28][29][30][31][32][33] Thus, in contrast to cutaneous lupus lesions, no uniformity exists in classifying oral lesions. Clinical descriptions of oral lupus lesions vary enormously in the different studies, and the terminology used to describe oral lesions in the scientific literature in patients with lupus is somewhat imprecise and varied, highlighting the following: 'lupus cheilitis', 'chronic plaques', 'oral discoid lesions', 'honeycomb plaques', 'lichen planus-like lesions', 'keratotic lesions', 'ulcerative plaques', 'oral ulcers', 'erythematous patches', 'pebbly red areas', 'purpuric lesions', enanthema and 'diffuse palatal petechial erythema'.…”

“…Clinical descriptions of oral lupus lesions vary enormously in the different studies, and the terminology used to describe oral lesions in the scientific literature in patients with lupus is somewhat imprecise and varied, highlighting the following: 'lupus cheilitis', 'chronic plaques', 'oral discoid lesions', 'honeycomb plaques', 'lichen planus-like lesions', 'keratotic lesions', 'ulcerative plaques', 'oral ulcers', 'erythematous patches', 'pebbly red areas', 'purpuric lesions', enanthema and 'diffuse palatal petechial erythema'. 4,9,10,12,13,17,18,[20][21][22][24][25][26][27][28][29][30][31][32][33] Thus, in contrast to cutaneous lupus lesions, no uniformity exists in classifying oral lesions. An adequate clinical categorization is lacking, and as a consequence, a comparison between existing studies is hampered.…”

“…Oral involvement ranges from 5% to 54% in systemic lupus erythematosus (SLE) and 3% to 25% in cutaneous lupus erythematosus (CLE) . Clinical descriptions of oral lupus lesions vary enormously in the different studies, and the terminology used to describe oral lesions in the scientific literature in patients with lupus is somewhat imprecise and varied, highlighting the following: ‘lupus cheilitis’, ‘chronic plaques’, ‘oral discoid lesions’, ‘honeycomb plaques’, ‘lichen planus–like lesions’, ‘keratotic lesions’, ‘ulcerative plaques’, ‘oral ulcers’, ‘erythematous patches’, ‘pebbly red areas’, ‘purpuric lesions’, enanthema and ‘diffuse palatal petechial erythema’ . Thus, in contrast to cutaneous lupus lesions, no uniformity exists in classifying oral lesions.…”