Oral manifestations of lupus erythematosus

Oral manifestations occur in approximately 25% of patients with lupus erythematosus (LE), but detailed descriptions of site distribution and subtype morphology remain limited.

To characterize the clinical patterns of oral involvement across lupus subtypes and assist clinicians in differentiating these from other oral mucosal conditions.

The records of 42 patients with oral LE (OLE) seen by the oral medicine and dermatology services at Guy's Hospital, London, were reviewed. There were 23 patients with discoid LE (DLE), 17 with systemic LE (SLE) and 2 with subacute cutaneous LE (SCLE). Clinical features, histopathology findings and serology results were recorded.

The median age of the patients was 50 years, and there was a marked female predominance. The buccal mucosa and hard palate were the most frequently affected sites across all subtypes, with the lip and gingiva more frequently involved in DLE. Erythema and striae were the predominant features, with dyspigmentation, plaques and ulceration being less common. Site distribution and clinical features were similar between DLE, SLE and SCLE.

OLE typically presents with horizontal, parallel, white striae radiating from a central erythematous or ulcerated focus, a pattern that can help distinguish it from oral lichen planus. There were no clear distinguishing features between LE subtypes identified in our cohort. Earlier diagnosis and multidisciplinary management may be achieved through timely recognition.