Oral lesions in systemic lupus erythematosus. Do ulcerative lesions represent a necrotizing vasculitis?

BACKGROUND: It has been suggested that oral lesions in patients with systemic lupus erythematosus (SLE) may be grouped clinically as erythema, discoid lesions, or oral ulcerations. Oral ulcerations have been said to foretell a severe systemic disease flare and the proposal that oral ulcers represent a mucosal vasculitis has been suggested to explain this hypothesis. OBJECTIVE: Our objective was to test the hypothesis that oral ulcers in patients with SLE result from vasculitis. METHODS: We studied 10 patients with American College of Rheumatology (ACR) criteria for a diagnosis of SLE who had oral lesions of lupus (six prospectively and four retrospectively) clinically and by routine and immunofluorescence microscopy. Biopsy specimens were reviewed in a single-blinded fashion. RESULTS: In our patients, no oral lesion, regardless of morphology, demonstrated vasculitis histologically. All lesions demonstrated an interface mucositis. CONCLUSION: Our data strongly contradict the hypothesis that leukocytoclastic vasculitis explains a possible unproven correlation between oral ulceration and disease flares in patients with SLE.

Papular dermatitis in adults: subacute prurigo, American style?

Determining the best treatment for recurrent pruritic papular eruptions that do not fit well into a diagnosis (of either atopy or some other diagnosis) is sometimes frustrating. We have studied 12 patients with recurrent pruritic papular eruptions by obtaining extensive histories and by performing skin biopsies, immunofluorescence studies, and screening patch tests. The eruptions in this group are not atopic by strict criteria but have atopic features and are without a determinable exogenous cause. Histologic features resemble papular urticaria, but there is no history to suggest arthropod bites. Patients with this type of eruption have features similar to those with subacute prurigo, and they respond to variable combinations of topical or systemic corticosteroids, systemic antihistamines, and UVB or UVA. We suggest that the designation of subacute prurigo might be more appropriate for patients with these findings.

Sarcoidosis of the upper respiratory tract in patients with nasal rim lesions: a pilot study.

Lupus pernio has been associated with sarcoidosis of the upper respiratory tract. The semantic differences in the use of the designation "lupus pernio" are such that American dermatologists may not consider patients with nasal rim papules of sarcoidosis to have lupus pernio. During a 12-month period, we referred each new patient with sarcoidosis and nasal rim lesions for direct and indirect laryngoscopy. Three of our four patients had sarcoidosis of the upper respiratory tract. We recommend a large prospective study to assess the incidence of this disorder in patients with nasal rim lesions of sarcoidosis. Until such a study is undertaken, however, we believe that consideration should be given to otolaryngologic examination of these patients, regardless of their symptoms.