Dermatology - Oropharyngeal Manifestations of Lupus Erythematosus.
About 25% of individuals with persistent cutaneous lupus erythematosus get mucosal involvement. Lupus erythematosus is a severe autoimmune disease that affects multiple systems in the body, specifically targeting connective tissue and blood vessels. Prevalence of this condition is ninefold higher in women compared to men, and it is more prevalent among individuals of African heritage. The onset typically occurs in the third or fourth decade of life, and risk factors for this condition include a family history of the disease and exposure to ultraviolet (UV) radiation. Arthralgia or arthritis, abdominal pain, and CNS symptoms are accompanied by fatigue, fever, weight loss, and malaise. Ulcers develop in purpuric necrotic lesions of the palate (80%), buccal mucosa, or gums in cases of acute systemic lupus erythematosus. Oropharyngeal lesions in chronic lupus are found in several locations, including the buccal mucosa, palate, alveolar process, tongue, and vermilian border of the lips. The lesions initially appear as painless red spots that gradually develop into long-lasting plaques. These plaques have well defined edges with irregularly shaped white borders, accompanied by white streaks and visible dilated blood vessels. Central depression and painful ulceration manifest in more mature lesions. The skin lesions persist for a duration ranging from weeks (acute) to months (chronic) and are accompanied by itching or a burning sensation. Chronic lupus skin lesions manifest as vivid red bumps that develop into well-defined, circular or oval-shaped, ring-like or multi-cyclic patches with uneven edges and stubborn scales that are challenging to eliminate. Plaques undergo peripheral expansion and central regression, leading to atrophy and scarring. "Burned out" lesions might appear as pink or white macules and scars, but they can also be hyperpigmented. The diagnosis is established by evaluating clinical symptoms, histology, lupus band test, and serology according to the revised criteria set by the American Rheumatism Association (ARA). Recommendation: Encourage the individual to relax and avoid exposure to ultraviolet (UV) radiation. Administer prednisone at a dosage of 60 mg per day, divided into many doses. Additionally, consider using immunosuppressants if there is involvement of the central nervous system or kidneys, hemolytic crises, thrombocytopenia, or severe sickness. Hydroxychloroquine is effective in treating skin lesions during the subacute and chronic periods, but it does not decrease the requirement for prednisone. Adhere to safety measures when use hydroxychloroquine. Other options encompass chloroquine or quinacrine.
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