Oral Manifestations of Lupus Erythematosus: Diagnosis & Treatment

Overview of Lupus Erythematosus

Systemic lupus erythematosus (SLE), or lupus for short, is a chronic and generally progressive autoimmune disease affecting many tissues in the body (Lupus Foundation of America, 2015). The U.S. Centers for Disease Control and Prevention (CDC, 2015) distinguishes between SLE and lupus affecting the skin only (discoid/cutaneous lupus erythematosus, or CLE) or lupus caused by medications (temporary). SLE and CLE are the only two types of lupus relevant to this discussion, since medication-induced lupus can be treated effectively by changing the offending medication. Prevalence estimates vary considerably, but in the United States an estimated 161,000 individuals have a definitive diagnosis of SLE. Information about incidence rates is equally limited, but the most recent study found that 5.6 out of 100,000 White individuals in Rochester, Minnesota developed SLE between 1980 and 1992. What follows is a detailed examination of lupus erythematosus (LE), its oral manifestations, and the recommended treatment approaches.

Lupus is caused by a malfunction of the immune system and the generation and expansion of auto-antibodies that target healthy tissue (Lupus Foundation of America, 2015). The targeted tissues suffer from chronic, often progressively painful inflammation and localized tissue damage. Although the disease can manifest at any point in a person's lifespan, minority women between the ages of 15 and 40 represent the demographic with the highest incidence rates (CDC, 2015). The cause of the disease is unknown, but infections or other environmental factors may trigger disease onset in genetically susceptible individuals (Mayo Clinic Staff, 2014a). Only a small number of individuals with a family history of autoimmune disease will develop LE, making it difficult to predict which family members are at risk.

The signs and symptoms associated with SLE include arthritis, skin rashes, photosensitivity, pleuritis, pericarditis, blood cell abnormalities, kidney problems, seizures, and psychosis. Most relevant to this discussion is the manifestation of oral ulcers. The primary treatment approaches rely on the administration of immunosuppressants, which are effective in slowing disease progression and minimizing flares. Flares can be life-threatening, and hospitalizations are not uncommon among this patient population. In the absence of a diagnosis and effective treatment, the risk of serious complications and even death is significant.