Oral Ulcers in Juvenile-Onset Systemic Lupus Erythematosus: A Review of the Literature

Abstract

Oral ulcers are the most common mucosal sign in juvenile-onset systemic lupus erythematosus (JSLE). The ulcers are one of the key clinical features; however, the terminology of oral ulcers, especially in JSLE patients, is often vague and ill-defined. In fact, there are several clinical manifestations of oral ulcers in JSLE, and some lesions occur when the disease is active, indicating that early management of the disease should be started. Oral ulcers are classified as lupus erythematosus (LE) specific, where the lesional biopsy shows a unique pattern of mucosal change in LE, and LE nonspecific, where the ulcers and their histopathological findings can be found in other oral diseases. Here, the clinical manifestations, diagnosis and management of oral ulcers in JSLE patients are reviewed.

Fig. 1

Oral ulcers in JSLE patients and their differential diagnoses. a–c LE-specific oral ulcers: a a palatal erythematous ulcer at hard palate; b a painful oral discoid LE with well-demarcated radiating white striae at left buccal mucosa; c verrucous LE at alveolar ridge. d–e LE-nonspecific oral ulcers: d multiple aphthous ulcers with erythematous halo at soft palate; e extensive erosive lupus cheilitis at both upper and lower lips. f–h The differential diagnoses: f an oral lichen planus with typical white reticular striae (Wickham striae) at left buccal mucosa and retromolar trigone; g an oral lichenoid contact lesion associated with large amalgam filling at left maxillary first molar (arrow); h clinical improvement 2 weeks after replacement with non-metal restoration. JSLE juvenile-onset systemic lupus erythematosus, LE lupus erythematosus