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BFUDJ, Volume 2 Number 2 October, 2011 (SUPPLEMENT ISSUE)
53significant risks in experienced hands .Oral steroids may be
required for thecontrol of systemic lupus but are notgenerally
beneficial n DLE. Forpatients with progressiveordisseminated
disease or in those withlocalized disease hatdoes not respondto
topical measures, the addition ofsystemicagents should be
considered.Treatment with antimalarial drugsconstitutes first-line
systemic therapyfor DLE. Therapy with antimalarials,either used
singly or in combination isusually effective. The 3 commonly
usedpreparations include chloroquine,hydroxychloroquin, and
mepacrine lo.Our patient was treated with topicalcorticosteroids
and is under ollowup.The histopathogy of DLE is
oftenindistinguishable from that of lichenplanus or other subtypes
of LE, such assubacute lupus erythematosus(SCLE). A few subtle
differencesinclude the fact that the connectivetissue lymphocytic
nfiltrate tends to besparser in LE than it is in LP ',
whileperivascular infiltrates composed ofplasma cells are more
often noted in LEthan in LP. Direct mmunofluorescencemay be of some
help, but it is notpathognomonic. The lupus band test, atest where
the presence ofimmunoglobulin and complement isevaluated by
immunofluorescence orimmunoperoxidase means, is positivein all
subsets of LE at varyingfrequency, but may also be positive inother
types of unrelated conditionssuch as lichen planus and, in the
skin,rosacea, solar keratosis,dermatomyositisand other
conditionsThe significance of DLE manifestationsin the oral mucosa
is uncertain.Although some consider t a signfavoring progression to
systemic LE,this association has not been proven .So far, our
patient has notdemonstrated any positivity nserologic tests,
despite regularscreening. Thus, the diagnosis remainsthat of DLE.
This diversity in clinicalmanifestations is characteristic of
theoverlap often observed among differentsubtypes of lupus
erythematosus 2.CONCLUSION:Lupus erythematosus s a
chronicdermatological disease with aprolonged course and can have
aconsiderableeffect onqualityof life.Early recognition and
treatmentimproves the prognosis. The diagnosisis usually made by
clinical examinationand histopathologymay be required o
confirm the diagnosis in some patientsalong with serologic
evaluation.BIBLIOGRAPHY1. Serpico R, Pannone G, Santoro A,Mezza E
et al. Report of a case ofdiscoid lupus erythematosus localisedto
the oral cavity: immunofluorescencefindings. lnt J
lmmunopatholPharmacol. 2007 Jul-Sep;20(3):651-3.2. Panjwani S.
Early diagnosis andtreatment of discoid lupuserythematosus. J Am
Board Fam Med.2009 Mar-Apr;22(2):206-13.3. Kuhn A, Rondinone R,
Doria A,ShoenfeldY. 1st InternationalConference on Cutaneous
LupusErythematosus Dusseldorf, Germany,September 1-5,2004.
Autoimmun Rev2005: 4: 66-78.4. Seitz CS, Brocker EB, Trautmann
A.Linear variant of chronic cutaneouslupus erythematosus: a clue
for thepathogenesis of chronic cutaneouslupus erythematosus?
Lupus.2008; 17: 11365. Julia M, Mascaro JM Jr, GuilabertA,Navarra
E, Ferrando J, Herrero C.Sclerodermiform inear upuserythematosus:a
distinct entity orcoexistence of two autoimmunediseases? J Am Acad
Dermatol.2008;58:665-7.6. Rhodus NL, Johnson DK. Theprevalence of
oral manifestations ofsystemic upus erythematosus.Quintessence Int.
1990;21(6): 461-465.7. Burge SM, Frith PA, Juniper RP,Wojnarowska
F. Mucosal involvementin systemic and chronic cutaneouslupus
erythematosus. Br J Dermatol.1989Dec; 121 6):727-41.8.
Warnakulasuriya S, Johnson NW,Waal I. Nomenclatureandclassification
of potentially malignantdisorders of the oral mucosa. J OralPathol
Med. 2007;36(10):575-580.9. Callen JP. Cutaneous upuserythematosus:
a personal approach omanagement. Australas J Dermatol2006; 47:
13-27.10. Callen JP. Treatment of cutaneouslesions n patients with
lupuserythematosus. Dermatol Clin 1994;12: 201-6.11. McKee PH,
Calonje E, Granter SR.Pathology of the skin. 3.
Philadelphia:Elsevier; 2005.12. Walling HW, Sontheimer RD.Cutaneous
lupus erythematosus:issues in diagnosis and treatment. AmJ Clin
Dermatol. 2009; 10(6):365-381
LEGENDSI -
Figure 1 Clin. , , .,... ng lesionsinvolving buccal mucosa and
tongue.
Figure 2: Clinical picture showing lesionsinvolving the
gingiva
Figure 3: Photomicrograph showingatrophied epithelium with
vascularconnective tissue stroma (H &E, 1Ox)
Figure 4: Photomicrograph showingbasal cell degeneration
(H&E, 40x)
Figure 5: Photomicrograph showingpatch deposits of PAS positive
materialin the epithelium-connective issueinterface (PAS, 40 x)
Source of Support: i, Conflict of Interest: None Declared
