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Saeed HM, Mohammad Amr E, Rezk Lotfy Rezk A, Abd Elmoneim W. Prevalence of oral manifestations in patients with lupus erythematosus in a sample of the Egyptian population: a hospital based cross-sectional study. F1000Res 2021; 10:969. [PMID: 35707453 PMCID: PMC9178282 DOI: 10.12688/f1000research.55332.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Several systemic diseases manifest themselves in the oral cavity. Dentists who are unaware of these lesions will possibly miss them. This cross-sectional study aimed to assess the prevalence of oral manifestations in patients with LE in a sample of the Egyptian population. Methods: The present cross-sectional study was performed on 189 patients attending the Internal Medicine Department, Rheumatology Clinic in EL Qasr El Ainy Hospital, Cairo University. Every patient was examined clinically after completing a questionnaire. Patients' medical records were evaluated. The oral manifestations were assessed according to the WHO guide to physical examination of the oral cavity and classified according to their morphologic aspects and localization. Results: Out of 189 patients, there were 182 females (96.3%) and seven males (3.7%). The prevalence of oral lesions in SLE patients was 55.6%. The most affected site was the tongue 25.7%. The most common clinical aspect was patches, 53%. About 77.1% of the lesions were asymptomatic. Conclusions: The present study emphasizes the importance of early diagnosis of oral lesions to recognize patients with SLE as the WHO considers oral manifestations of SLE a widespread state. Also, the implementation of oral hygiene measures to improve patients' nutritional state and health-related quality of life is recommended.
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Affiliation(s)
- Hager Moustafa Saeed
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Eman Mohammad Amr
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
| | | | - Wesam Abd Elmoneim
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
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2
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Saeed HM, Mohammad Amr E, Rezk Lotfy Rezk A, Abd Elmoneim W. Prevalence of oral manifestations in patients with lupus erythematosus in a sample of the Egyptian population: a hospital based cross-sectional study. F1000Res 2021; 10:969. [PMID: 35707453 PMCID: PMC9178282 DOI: 10.12688/f1000research.55332.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/06/2023] Open
Abstract
Background: Several systemic diseases manifest themselves in the oral cavity. Oral manifestations of lupus erythematosus (LE) are associated with a significantly increased risk of cancer. Dentists who are unaware of these lesions will possibly miss them. This cross-sectional study aimed to assess the prevalence of oral manifestations in patients with LE in a sample of the Egyptian population. Methods: A descriptive study was performed on 189 patients attending the Internal Medicine Department, Rheumatology Clinic in EL Qasr EL Ainy Hospital, Cairo University. Every patient was examined clinically after completing a questionnaire. Moreover, patients' medical records were also evaluated. The oral manifestations were recorded according to the WHO guide to physical examination of the oral cavity and classified according to their morphologic aspects and localization. Results: Out of 189 patients, there were 182 females (96.3%) and seven males (3.7%). The prevalence of oral lesions in LE patients was 55.6%. The most affected site was the tongue 25.7%. The most common clinical aspect was patches, 53%. About 77.1% of the lesions were asymptomatic. Conclusions: The present study emphasizes the importance of early diagnosis of oral lesions to recognize patients with LE as the WHO considers oral manifestations of LE a widespread state. Also, implementation of oral hygiene measures and treatment to improve patients' nutritional state and health-related quality of life are recommended.
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Affiliation(s)
- Hager Moustafa Saeed
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Eman Mohammad Amr
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
| | | | - Wesam Abd Elmoneim
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
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3
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Saeed HM, Mohammad Amr E, Rezk Lotfy Rezk A, Abd Elmoneim W. Prevalence of oral manifestations in patients with lupus erythematosus in a sample of the Egyptian population: a hospital based cross-sectional study. F1000Res 2021; 10:969. [PMID: 35707453 PMCID: PMC9178282 DOI: 10.12688/f1000research.55332.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/06/2023] Open
Abstract
Background: Several systemic diseases manifest themselves in the oral cavity. Dentists who are unaware of these lesions will possibly miss them. This cross-sectional study aimed to assess the prevalence of oral manifestations in patients with LE in a sample of the Egyptian population. Methods: A descriptive study was performed on 189 patients attending the Internal Medicine Department, Rheumatology Clinic in EL Qasr EL Ainy Hospital, Cairo University. Every patient was examined clinically after completing a questionnaire. Moreover, patients' medical records were also evaluated. The oral manifestations were recorded according to the WHO guide to physical examination of the oral cavity and classified according to their morphologic aspects and localization. Results: Out of 189 patients, there were 182 females (96.3%) and seven males (3.7%). The prevalence of oral lesions in SLE patients was 55.6%. The most affected site was the tongue 25.7%. The most common clinical aspect was patches, 53%. About 77.1% of the lesions were asymptomatic. Conclusions: The present study emphasizes the importance of early diagnosis of oral lesions to recognize patients with SLE as the WHO considers oral manifestations of SLE a widespread state. Also, implementation of oral hygiene measures and treatment to improve patients' nutritional state and health-related quality of life are recommended.
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Affiliation(s)
- Hager Moustafa Saeed
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Eman Mohammad Amr
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
| | | | - Wesam Abd Elmoneim
- Department of Oral Medicine and Periodontology, Cairo University, Cairo, 11562, Egypt
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Wang H, Gao Q, Liao G, Ren S, You W. Clinico-Laboratory Features and Associated Factors of Lupus Mesenteric Vasculitis. Rheumatol Ther 2021; 8:1031-1042. [PMID: 34050908 PMCID: PMC8217476 DOI: 10.1007/s40744-021-00323-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Lupus mesenteric vasculitis (LMV) is a rare but potentially life-threatening clinical entity in systemic lupus erythematosus (SLE) patients. Objective The present study was initiated to explore the clinical features and associated factors of LMV in SLE patients. Methods We conducted a retrospective study on 50 cases of SLE patients with lupus mesenteric vasculitis (LMV) from January 2010 to December 2019 and 89 cases of non-LMV-SLE patients with similar demographic and comorbidities were included as control. All the data regarding clinical features, laboratory findings, and treatment were reviewed independently by two experts in the field. Both univariate and multivariate logistic regression analyses were employed to identify the associated factors of LMV. Results The incidence of LMV was 2.9% among hospitalized SLE patients in the current study. The most frequent symptom and physical sign of LMV were respectively abdominal pain (48, 96%) and abdominal tenderness (45, 90%). Through univariate and subsequent multivariate analysis, oral ulcer (OR, 4.25; P = 0.024), urinary tract involvement (OR, 5.23; P = 0.021), and elevated D-dimer (OR, 1.121; P = 0.008) were demonstrated to be positively associated with LMV, while percentage of lymphocytes (OR, 0.928; P = 0.004) and complement 3 (OR, 0.048; P = 0.008) were negatively correlated with LMV. Conclusions Oral ulcer, urinary tract involvement, reduced percentage of lymphocytes and complement 3, elevated D-dimer could be associated factors for LMV in SLE patients.
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Affiliation(s)
- Hongxu Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qing Gao
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Guanyi Liao
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Sirui Ren
- Department of Intensive Care Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wenxian You
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Abstract
Chronic oral mucosal lesions can be associated with several mucocutaneous diseases. This article reviews the autoimmune and immune-mediated, reactive, genetic, and infectious diseases that may present with chronic oral and/or cutaneous manifestations and provides a rational approach to diagnosis and management.
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Benli M, Batool F, Stutz C, Petit C, Jung S, Huck O. Orofacial manifestations and dental management of systemic lupus erythematosus: A review. Oral Dis 2020; 27:151-167. [PMID: 31886584 DOI: 10.1111/odi.13271] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/14/2019] [Accepted: 12/24/2019] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune multisystem disease with numerous clinical manifestations. There is no consensus about the ideal oral management for this group of patients to date. This review aimed to describe the broad spectrum of orofacial and clinical manifestations and their therapeutic approaches. Studies concerning orofacial manifestations of SLE and dental treatment modalities were selected by a literature search (1978-2019) using Google Scholar, PubMed/MEDLINE electronic databases. The initial search strategy provided a total of 129 articles, and of these, 30 were included for qualitative synthesis. The reviewed studies revealed that SLE patients are more at risk of compromised oral and dental health exhibiting increased risk of periodontal diseases and temporomandibular joint disorders. The use of systemic drugs especially immunosuppressive and anticoagulants in SLE patients may also influence their oral management. Results emphasize the need to carry out, at an early stage of the disease, an appropriate oral management of these patients to improve oral health-related quality of life and to prevent the need of more invasive therapeutics. A multidisciplinary approach is needed for dental and medical management of such patients.
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Affiliation(s)
- Merve Benli
- Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Fareeha Batool
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
| | - Céline Stutz
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Catherine Petit
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France.,Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sophie Jung
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France.,Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,CNRS UPR 3572 "Immunologie, Immunopathologie et Chimie Thérapeutique (I2CT)", Institut de Biologie Moléculaire et Cellulaire (IBMC), Strasbourg, France
| | - Olivier Huck
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France.,Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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7
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Carrozzo M, Porter S, Mercadante V, Fedele S. Oral lichen planus: A disease or a spectrum of tissue reactions? Types, causes, diagnostic algorhythms, prognosis, management strategies. Periodontol 2000 2019; 80:105-125. [PMID: 31090143 DOI: 10.1111/prd.12260] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oral lichen planus and lichenoid lesions comprise a group of disorders of the oral mucosa that likely represent a common reaction pattern to 1 or more unknown antigens. The coexistence of hyperkeratotic striation/reticulation, varying degrees of mucosal inflammation from mild erythema to severe widespread ulceration, and a band-like infiltrate of mononuclear inflammatory cells including activated T lymphocytes, macrophages, and dendritic cells, are considered suggestive of oral lichen planus and lichenoid lesions. Several classification systems of oral lichen planus and lichenoid lesions have been attempted, although none seem to be comprehensive. In this paper, we present a classification of oral lichen planus and lichenoid lesions that includes oral lichen planus, oral lichenoid contact lesions, oral lichenoid drug reactions, oral lichenoid lesions of graft vs. host disease, discoid lupus erythematosus, and systemic lupus erythematosus, lichen planus-like variant of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome, chronic ulcerative stomatitis, lichen planus pemphigoides, solitary fixed drug eruptions, and lichen sclerosus. We present the clinical and diagnostic aspects of oral lichen planus and lichenoid lesions, and discuss related treatment options.
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Affiliation(s)
- Marco Carrozzo
- Centre for Oral Health Research, Oral Medicine Department, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Porter
- UCL Eastman Dental Institute, University College London, London, UK
| | | | - Stefano Fedele
- UCL Eastman Dental Institute, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
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8
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Del Barrio-Díaz P, Reyes-Vivanco C, Cifuentes-Mutinelli M, Manríquez J, Vera-Kellet C. Association between oral lesions and disease activity in lupus erythematosus. J Eur Acad Dermatol Venereol 2019; 34:349-356. [PMID: 31566809 DOI: 10.1111/jdv.15980] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mucosal involvement is frequently seen in cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE). There is no consensus regarding the prevalence, and a wide range of lesions has been reported. Its prognostic significance is currently unknown and a matter of controversy. OBJECTIVE To classify oral lesions in lupus, evaluate their prevalence and assess their possible association with disease activity. METHODS We conducted a descriptive study between 2016 and 2017. A total of 150 lupus patients were matched by sex, age and smoking status with 151 healthy individuals. All subjects underwent a careful evaluation of oral mucosa. On the same day of the clinical assessment, each patient underwent a peripheral venous blood and urine analysis. All patients underwent a full medical history, physical examination and a careful examination of the oral cavity. For each one, we obtained photographs of ten areas of the oral cavity. Two dermatologists of our group blindly recorded the presence and morphology of oral lesions. The disease activity of CLE patients was scored using the Revised Cutaneous Lupus Erythematosus Disease Area and Severity Index, and in SLE patients, activity was measured using the Systemic Lupus Erythematosus Disease Activity Index. RESULTS In CLE patients, there was a statistically significant correlation between higher cutaneous disease activity and the following oral findings: discoid plaques, cobblestone and red/brown-pigmented macules. In patients with CLE, red macules on jugal mucosa were statistically associated with anaemia and positive antinuclear antibodies titres; additionally, the presence of gingivitis was related to systemic inflammation. In SLE patients, gingival telangiectases were statistically significantly associated with leucopenia, hypocomplementemia and systemic inflammation. LIMITATIONS Biopsies on mucosal lesions were not performed. CONCLUSION Some specific oral lesions correlate with disease activity in CLE and SLE.
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Affiliation(s)
- P Del Barrio-Díaz
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Reyes-Vivanco
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Cifuentes-Mutinelli
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Manríquez
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Connective Tissue Diseases Unit, Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Vera-Kellet
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Connective Tissue Diseases Unit, Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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9
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Cheng YSL, Gould A, Kurago Z, Fantasia J, Muller S. Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:332-54. [PMID: 27401683 DOI: 10.1016/j.oooo.2016.05.004] [Citation(s) in RCA: 265] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/03/2016] [Accepted: 05/11/2016] [Indexed: 12/26/2022]
Abstract
Despite being one of the most common oral mucosal diseases and recognized as early as 1866, oral lichen planus (OLP) is still a disease without a clear etiology or pathogenesis, and with uncertain premalignant potential. More research is urgently needed; however, the research material must be based on an accurate diagnosis. Accurate identification of OLP is often challenging, mandating inclusion of clinico-pathological correlation in the diagnostic process. This article summarizes current knowledge regarding OLP, discusses the challenges of making an accurate diagnosis, and proposes a new set of diagnostic criteria upon which to base future research studies. A checklist is also recommended for clinicians to provide specific information to pathologists when submitting biopsy material. The diagnostic process of OLP requires continued clinical follow-up after initial biopsy, because OLP mimics can manifest, necessitating an additional biopsy for direct immunofluorescence study and/or histopathological evaluation in order to reach a final diagnosis.
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Affiliation(s)
- Yi-Shing Lisa Cheng
- Department of Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas, TX, USA.
| | - Alan Gould
- Louisville Oral Pathology Laboratory, Louisville, KY, USA
| | - Zoya Kurago
- Department of Oral Health and Diagnostic Sciences, College of Dental Medicine, Augusta University, Augusta, GA, USA
| | - John Fantasia
- Department of Dental Medicine, Hofstra North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - Susan Muller
- Professor Emeritus, Emory University School of Medicine, Atlanta, GA; Atlanta Oral Pathology, Decatur, GA, USA
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10
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Nico MMS, Bologna SB, Lourenço SV. The lip in lupus erythematosus. Clin Exp Dermatol 2015; 39:563-9. [PMID: 24934909 DOI: 10.1111/ced.12368] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2013] [Indexed: 12/14/2022]
Abstract
Lupus erythematosus (LE) frequently compromises the skin, lips and oral mucosa. There is a large body of medical and dental literature about the cutaneous and mucosal lesions of LE, but very little has been written specifically about labial lupus. The lip has a peculiar anatomical and histological architecture, and LE lesions at this site may have some distinct features. This article reviews the existing data and adds some new concepts to the issue of labial lupus in all of its presentations, comparing such lesions to the well-established characterization of cutaneous LE (in acute, subacute and chronic lesions), and highlighting some special clinical features that may enable a better diagnosis and differential diagnosis of lip diseases.
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Affiliation(s)
- M M S Nico
- Department of Dermatology, Medical School, University of São Paulo, São Paulo, Brazil
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11
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Bascones-Martínez A, García-García V, Meurman JH, Requena-Caballero L. Immune-mediated diseases: what can be found in the oral cavity? Int J Dermatol 2014; 54:258-70. [PMID: 25514833 DOI: 10.1111/ijd.12681] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Immune-mediated diseases frequently affect oral mucosa, which may often be the first site of clinical manifestation. In this review, we describe the most important oral lesions related to inflammatory disorders and present their management and novel therapies. The review is based on an open PubMed literature search from 1980 to 2012 with relevant keywords. Pemphigus vulgaris, oral lichen planus, cicatricial pemphigoid, erythema multiforme, Stevens-Johnson syndrome, systemic lupus erythematosus, Sjögren's syndrome, and linear IgA dermatosis are the immune-mediated diseases with oral manifestations discussed. Etiology is unknown in most of these diseases, but recently some of them have been found to share common genes. Modern treatment of these diseases is based on drugs that interfere along the pathogenic mechanisms instead of the still commonly used palliative measures. However, the immunomodulatory drugs may also cause oral side effects, complicating the clinical picture. Therefore, consulting dental or oral medicine specialists can be necessary in some cases with various immune-mediated diseases.
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Affiliation(s)
- Antonio Bascones-Martínez
- Department of Stomatology III, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
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12
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Khudhur AS, Di Zenzo G, Carrozzo M. Oral lichenoid tissue reactions: diagnosis and classification. Expert Rev Mol Diagn 2014; 14:169-84. [DOI: 10.1586/14737159.2014.888953] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Liu W, Shen ZY, Wang LJ, Hu YH, Shen XM, Zhou ZT, Li J. Malignant potential of oral and labial chronic discoid lupus erythematosus: a clinicopathological study of 87 cases. Histopathology 2011; 59:292-8. [DOI: 10.1111/j.1365-2559.2011.03934.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Lo Russo L, Fedele S, Guiglia R, Ciavarella D, Lo Muzio L, Gallo P, Di Liberto C, Campisi G. Diagnostic Pathways and Clinical Significance of Desquamative Gingivitis. J Periodontol 2008; 79:4-24. [DOI: 10.1902/jop.2008.070231] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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López-Labady J, Villarroel-Dorrego M, González N, Pérez R, Mata de Henning M. Oral manifestations of systemic and cutaneous lupus erythematosus in a Venezuelan population. J Oral Pathol Med 2007; 36:524-7. [PMID: 17850434 DOI: 10.1111/j.1600-0714.2007.00569.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to characterize oral lesions in patients with systemic and cutaneous lupus erythematosus (LE) in a Venezuelan group. METHODS Ninety patients with LE were studied. Oral biopsies were taken from patients who showed oral mucosal involvement. Tissue samples were investigated with histology and direct immunofluorescence techniques for the presence of immunoglobulins G, M, A and complement factor C3. RESULTS In 90 patients with LE, 10 patients showed oral lesions related to the disease. Sixteen lesions were investigated. Oral ulcerations accompanied by white irradiating striae occurred in five patients, erythema was observed in five patients and a white homogeneous plaque in one patient. Fifteen lesions demonstrated vacuolar basal degeneration and 12 thickening of the basement membrane histologically. Direct immunofluorescence was negative in three samples. CONCLUSIONS These findings corroborated that ulcers are not the only manifestation of LE in the oral mucosa. Clinical and histological examinations are significant as immunoproteins are not always found on the oral sample.
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16
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Cardinali C, Giomi B, Caproni M, Fabbri P. Cutaneous Hypertrophic Lupus Erythematosus in a Patient With Systemic Involvement. Skinmed 2007; 3:49-51. [PMID: 14724415 DOI: 10.1111/j.1540-9740.2004.02588.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Carla Cardinali
- Department of Dermatological Sciences, University of Florence, Florence, Italy
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17
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Abstract
Cutaneous lupus erythematosus (CLE) is a heterogenous disorder with a wide range of skin manifestations. Therefore, it has been difficult to develop a unifying concept for classifying CLE from the dermatologic perspective in the past. In 2004, the classification system was updated and includes now acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), and intermittent CLE (ICLE). Additional rarely described variants are not listed as separate entities but are included in the classical forms. Diagnosis of the different subtypes of CLE is made by considering genetic, clinical, histopathologic, and immunoserologic findings, with a systematic analysis of individual criteria. In the past years, the etiology and pathogenesis of CLE has been subject of intensive research and it has been shown by several groups that exogenous factors, such as ultraviolet light and drugs, can induce CLE. The first part of this review will enable the reader to identify the various clinical manifestations of CLE and to employ characteristic criteria to assess differential diagnostic considerations.
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MESH Headings
- Biopsy
- Complement System Proteins/analysis
- Diagnosis, Differential
- Fluorescent Antibody Technique, Direct
- Humans
- Immunoglobulins/analysis
- Lupus Erythematosus, Cutaneous/classification
- Lupus Erythematosus, Cutaneous/diagnosis
- Lupus Erythematosus, Cutaneous/etiology
- Lupus Erythematosus, Cutaneous/pathology
- Lupus Erythematosus, Discoid/classification
- Lupus Erythematosus, Discoid/diagnosis
- Lupus Erythematosus, Discoid/etiology
- Lupus Erythematosus, Discoid/pathology
- Panniculitis, Lupus Erythematosus/classification
- Panniculitis, Lupus Erythematosus/diagnosis
- Panniculitis, Lupus Erythematosus/etiology
- Panniculitis, Lupus Erythematosus/pathology
- Skin/pathology
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Affiliation(s)
- A Kuhn
- Hautklinik der Heinrich-Heine-Universität Düsseldorf.
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18
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Abstract
Vasculitis in connective tissue diseases is not an uncommon complication. Vasculitis complicates both rheumatoid arthritis and systemic lupus erythematosis (SLE) in about 4% of cases. Cutaneous lesions, representing small-vessel involvement, are most common; however, widespread, necrotizing visceral medium-and large-vessel involvement, mimicking primary vasculitic syndromes, may also occur. Connective tissue disease-associated vasculitis is separated from primary vasculitis syndromes in classification schemes. Granulomatous large-vessel disease does not occur in connective tissue diseases, suggesting a different pathogenesis. In most disorders, the etiology of vascular inflammation in not completely understood, but basic pathogenic mechanisms can often be distinguished. The role of immune complexes in the inflammatory manifestations of SLE is recognized, and other pathogenic factors such as antineutrophil cytoplasmic antibodies, common in other vasculitides, are infrequent. A diverse spectrum of clinical features, due to inflammatory involvement of arterial and venous vessels of all sizes, characterize several connective tissue diseases including Behçet's disease and SLE. The recognition of disease manifestations due to vasculitis in these disorders has important implications for treatment and may be critical to reduce morbidity and mortality.
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Affiliation(s)
- Kenneth T Calamia
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida 32224, USA.
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19
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Abstract
Part of periodontology involves the diagnosis and treatment of a variety of non-plaque-related diseases of the periodontium. The International Workshop for a Classification of Periodontal Diseases and Conditions noted that the periodontist may be called upon to manage non-plaque-related mucocutaneous disorders either alone, or as part of a treatment team consisting of physicians, dentists or other allied health care professionals. This informational paper will review the etiology, clinical manifestations, diagnosis, and treatment of the most common chronic mucocutaneous diseases, including those that may present as desquamative gingivitis or intraoral vesiculobullous lesions. This paper is intended for the use of periodontists and other members of the dental profession.
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Abstract
White lesions are frequently found during the examination of the oral cavity. Although some benign physiologic entities may present as white lesions, systemic conditions, infections, and malignancies may also present as white oral lesions. An appreciation of the many clinical entities that white lesions may represent is necessary if a differential diagnosis of white lesions is to be elucidated. The appreciation of subtle clinical findings associated with white lesions of the oral cavity permits clinicians to better care for their patients.
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Affiliation(s)
- Diana V Messadi
- Section of Oral Medicine, Division of Oral Biology and Medicine, School of Dentistry, University of California Los Angeles, Box 951668, Los Angeles, CA 90095-1668, USA
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21
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Orteu CH, Buchanan JA, Hutchison I, Leigh IM, Bull RH. Systemic lupus erythematosus presenting with oral mucosal lesions: easily missed? Br J Dermatol 2001; 144:1219-23. [PMID: 11422045 DOI: 10.1046/j.1365-2133.2001.04236.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two caucasian patients are described in whom oral mucosal lesions were the first manifestation of systemic lupus erythematosus. In both cases the diagnosis was delayed despite histological examination of oral lesions. Treatment with antimalarials and azathioprine was of significant benefit. In the absence of cutaneous or systemic features, distinguishing oral lupus erythematosus from lichen planus and epidermal dysplasia can be difficult, both clinically and on histology, and requires a high index of suspicion.
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Affiliation(s)
- C H Orteu
- Department of Dermatology, The Royal London Hospital, Whitechapel, London E1 1BB, UK
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22
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Callen JP. Oral manifestations of collagen vascular disease. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1997; 16:323-7. [PMID: 9421226 DOI: 10.1016/s1085-5629(97)80024-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Lupus erythematosus is a multisystem disorder. One of its defining features is oral ulceration. In addition to oral ulcers, cheilitis may occur. Sjögren's syndrome is an autoimmune disorder of exocrine glands that causes a decrease in salivary gland function. This results in symptoms of xerostomia, which can be complicated by caries. Scleroderma has rare oral manifestations, which include a decrease in the maximal oral aperture and mat-like telangiectasias.
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Affiliation(s)
- J P Callen
- Department of Medicine, School of Medicine, University of Louisville, KY 40292, USA
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23
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Meyer U, Kleinheinz J, Gaubitz M, Schulz M, Weingart D, Joos U. [Oral manifestations in patients with systemic lupus erythematosus]. MUND-, KIEFER- UND GESICHTSCHIRURGIE : MKG 1997; 1:90-4. [PMID: 9410618 DOI: 10.1007/bf03043521] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Forty-six patients with systemic lupus erythematosus underwent thorough dental examination to determine the frequency and severity of oral lesions and periodontal diseases. According to clinical criteria, disease was classified as severe (n = 26) or less severe (n = 20). The overall rate of mucosal involvement in the studied patients was 48%-from 54% in patients with severe disease, 40% in those with less severe disease. Patients with severe disease were found to have a higher rate of tooth loss and an increased rate of gingival inflammation. The severity of periodontal lesions correlated with alterations in the immunoglobulin pattern, particularly with an increase in gamma-immunoglobulins. Thus it is suspected that complex immunodysregulation in combination with immunosuppressive therapy is responsible for the high rate of oral and periodontal lesions in patients with systemic lupus erythematosus.
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Affiliation(s)
- U Meyer
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universität Münster
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