[Oral lupus erythematosus. Description and analysis of 11 cases]. / Lupus eritematoso orale. Descrizione e analisi di 11 casi.

BACKGROUND: The aim of this study is to evaluate all the cases of lupus erythematosus with oral involvement coming to the Department of Oral Medicine in the last 15 years (1984-1998). METHODS: The files of the Oral Medicine Department of the University of Turin have been reviewed to search oral manifestations of lupus erythematosus according to international accepted diagnostic criteria. RESULTS: A total of eleven patients 7 women (64%) and 4 men (36%) with a mean age of 46 years were included. Three patients (27%) had discoid lupus erythematosus (LED) whereas 8 (73%) had systemic lupus erythematosus (LES). In four patients the diagnosis of lupus was made after oral diagnosis, whereas 7 patients (64%) had a previous diagnosis of lupus. Clinical aspect was typical in 8 cases (73%) while one patient had leukoplakia-like white patches and two patients (18%) had lichen-like oral lesion. CONCLUSIONS: This study suggest that primitive oral lesion of lupus are quite rare but frequently may have atypical features often difficult to differentiate from lichen planus.

[Erythema multiforme. A heterogeneous pathologic phenotype]. / Eritema multiforme. Un fenotipo patologico eterogeneo.

The term Erythema Multiforme (EM) include actually a wide range of clinical expressions, from exclusive oral erosions (Oral EM) to mucocutaneous lesions (EM Minor), sometimes with severe involvement of multiple mucosal membrane (EM major, Stevens-Johnson syndrome [SJS]) or with involvement of a large area of the total body surface (toxic epidermal necrolysis [TEN]). However, this terminology is not worldwide accepted and often the various clinical categories show some overlapping features. Among the great number of suspected etiological factors, herpes simplex virus is involved in many cases of EM minor whereas SJS and TEN are caused in 80% of cases by systemic drugs, mainly by anticonvulsivants, sulfonamides, nonsteroidal anti-inflammatory drugs and antibiotics. Several oral EM seem idiopathic, but data on this topic are very few. There is no specific or consistent microscopic and immunopathologic pattern of EM and the diagnosis should be done by excluding other similar diseases. The treatment include the use of antivirals for EM minor, mainly if recurrent, and of immunosuppressants (especially systemic corticosteroids) for SJS. TEN patients require adequate supportive care and often they have to be treated in emergency departments. Finally, patients with exclusive oral lesions may be treated with both topical and systemical corticosteroids.