Oral involvement in lupus erythematosus: A report of three cases

Mariem Rekik, Khadija Sellami, Massara Baklouti, Emna Bahloul, Hamida Turki

Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia

Corresponding author: Mariem Rekik, MD, E-mail: mariemrekik994@gmail.com

How to cite this article: Rekik M, Sellami K, Baklouti M, Bahloul E, Turki H. Oral involvement in lupus erythematosus: A report of three cases. Our Dermatol Online. 2022;13(4):467-468.
Submission: 05.03.2022; Acceptance: 31.07.2022
DOI: 10.7241/ourd.20224.31

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© Our Dermatology Online 2022. No commercial re-use. See rights and permissions. Published by Our Dermatology Online.


Lupus erythematosus (LE) is an autoimmune disease that may rarely affect the oral mucosa. This mucosal damage may be mistaken for lichen planus. Herein, we report three cases of oral lupus.

Observation 1: A 41-year-old female, with a seven-year history of systemic LE (SLE) treated with hydroxychloroquine, presented for recent food discomfort. An examination of the oral mucosa found an erythematous plaque on the palate (Fig. 1) and whitish macules on the cheek mucosa. A palatal biopsy was in favor of lupus.

Figure 1: Erythematous patch of the palate (patient 1).

Observation 2: A 47-year-old female presented with a clinical picture of SLE, with diffuse lichenoid ulcerations of the oral cavity (Figs. 2a and 2b). The workup confirmed SLE with severe renal impairment requiring treatment with oral methylprednisolone combined with cyclophosphamide boluses. Oral involvement improved markedly.

Figure 2: (a) Superficial ulcerations with a whitish, lichenoid background of the palate; erosive cheilitis (patient 2). (b) Similar lesions in the right cheek mucosa (patient 2).

Observation 3: A ten-year-old child presented with photosensitivity. An examination found erythematous plaques on the cheekbones and nose and atrophic hypochromic macules with a scaly surface on the forearms. A skin biopsy concluded the diagnosis of subacute lupus (SAL). Direct immunofluorescence was negative. Four months later, at follow-up, erythematous macules were noted on the palate and on the inside of the lips with angular stomatitis (Figs. 3a and 3b). A mucosal biopsy was refused by the patient.

Figure 3: (a) Erythematous macules of the palate; bilateral perlèche (patient 3). (b) Erythematous macules on the inside of the lips (patient 3).

Oral involvement in LE is rare. In a study by Menzies et al., 50% of patients with lupus showed positive oral findings [1]. This condition is associated with a worsened health-related oral quality of life [2]. During SLE, the involvement of the oral mucosa may manifest as erosions or atrophic lesions with whitish striations, which may mimic lichen planus. The lips, palate, cheek mucosa, and tongue could be affected [3]. Oral involvement may persist for years or occur only during relapses [4]. In SAL, the most frequent oral involvement is that of the palate with erythematous plaques, sometimes petechial or keratotic patches or erosions [5]. The labial and gingival mucous membranes could also be affected. Chronic lupus causes mucosal damage similar to that in SLE [3].

The specific involvement of the oral mucosa in LE is difficult to diagnose. It seems to be underdiagnosed. An examination of the oral cavity should be part of the clinical examination of any patient with lupus.


The examination of the patient was conducted according to the principles of the Declaration of Helsinki.

The authors certify that they have obtained all appropriate patient consent forms, in which the patients gave their consent for images and other clinical information to be included in the journal. The patients understand that their names and initials will not be published and due effort will be made to conceal their identity, but that anonymity cannot be guaranteed.


1. Menzies S, O’Shea F, Galvin S, Wynne B. Oral manifestations of lupus. Ir J Med Sci. 2018;187:91-3.

2. Correa JD, Branco LGA, Calderaro DC, Mendonça SMS, Travassos DV, Ferreira GA, et al. Impact of systemic lupus erythematosus on oral health-related quality of life. Lupus. 2018;27:283-9.

3. Simoes DM, Fava M, Figueiredo MA, Salum FG, Cherubini K. Oral manifestations of lupus erythematosus:Report of two cases. Gerodontology. 2013;30:303-8.

4. Heath KR, Rogers RS, Fazel N. Oral manifestations of connective tissue disease and novel therapeutic approaches. Dermatol Online J. 2015;21:13030/qt7030d6gd.

5. Nico MM, Romiti R, Lourenço SV. Oral lesions in four cases of subacute cutaneous lupus erythematosus. Acta Derm Venereol. 2011;91:436-9.


Source of Support: Nil,

Conflict of Interest: The authors have no conflict of interest to declare.


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