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J Cutan Pathol 2007: 34: 558–564 doi: 10.1111/j.1600-0560.2006.00652.x Blackwell Munksgaard. Printed in Singapore

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Blackwell Munksgaard 2006

Journal of

Cutaneous Pathology

Lupus erythematosus: Clinical and histopathological study of oral manifestations and immunohistochemical profile of the inflammatory infiltrate
Background: Lupus erythematosus (LE) is amultifactorial autoimmune disease, which may affect the oral mucosa in either its cutaneous and systemic forms, with varied prevalence. Methods: Forty-six patients with confirmed diagnosis of LE, presenting oral lesions were included in the study. Oral mucosal lesions were analyzed clinically, their histopathological features were investigated and inflammatory infiltrate constitution was assessed usingimmunohistochemistry against the following clusters of differentiation: CD3, CD4, CD8, CD20, CD68 and CD1a. Results: From 46 patients with specific LE oral lesions 34 were females (25 with cutaneous LE and nine with systemic LE) and 12 were males (11 with cutaneous LE and one with systemic LE). Clinical aspects of lesions varied, and lips and buccal mucosa were the most affected sites. Histologically,lesions revealed lichenoid mucositis with perivascular infiltrate and thickening of basement membrane. Inflammatory infiltrate was predominantly composed by T lymphocytes of the CD4 subtype, with a minor prevalence of B lymphocytes, isolated macrophages and rare Langerhans cells. Conclusions: Oral lesions of lupus erythematosus show a variety of clinical aspects and histologically consist of alichenoid mucositis with deep inflammatory infiltrate, composed predominantly of T CD4 positive lymphocytes. Lourenco SV, de Carvalho FRG, Boggio P, Sotto MN, Vilela MAC, x Rivitti EA, Nico MMS. Lupus erythematosus: Clinical and histopathological study of oral manifestations and immunohistochemical profile of the inflammatory infiltrate. J Cutan Pathol 2007; 34: 558–564. # Blackwell Munksgaard 2006.Silvia V. Lourenco, Fabio R. G. x de Carvalho, Paula Boggio, Mirian N. Sotto, Maria A. C. Vilela, Evandro A. Rivitti and Marcello M. S. Nico
Department of Dermatology, Medical School, ˜ University of Sao Paulo, Brasil

Silvia V. Lourenc DDS, PhD, Instituto de Medicina xo ´ ˜ Tropical de Sao Paulo, Laboratorio de ´ Imunopatologia, Av. Dr. Eneas de Carvalho Aguiar, ˜ 500, 2° andar, CEP:05403-000, Sao Paulo, SP, Brazil Tel/Fax: 155 11 3061 7065 e-mail: sloducca@usp.br Accepted for publication July 19, 2006

Lupus erythematosus (LE) is a chronic inflammatory condition, considered the prototype of autoimmune human disease. Its cause is still unknown and genetic, immunologic, hormonal and environmental factors have been implicated in its pathogenesis. The disease is more prevalent amongstwomen

of childbearing age, although it can affect both sexes equally at any age. Classically, LE has been subdivided into a systemic and a cutaneous form. While systemic lupus erythematosus (SLE) is a multiorgan disease with variable prognosis, cutaneous lupus erythematosus (CLE) is a more

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benign condition – limited to skin and/or mucosal surfaces.1–3The prevalence of mucosal involvement in LE patients is debatable. Some authors suggest that oral lesions are present in 9–45% of patients with the systemic form of the disease and in 3–20% in those with CLE.4–6 The present study was undertaken (1) to study the clinical aspects of oral mucosal lesions specific to LE; (2) to study the main histopathological features of these mucosal lesions; and (3)to assess the composition of the inflammatory infiltrate involved in the oral lesions of LE using immunohistochemistry. lightly counterstained with Mayer’s hematoxylin, dehydrated and mounted with glass cover slip and xylene-based mountant. Negative controls were treated as above, but a solution of 1% BSA in Tris–HCL pH 7.4 replaced the primary antibody. Normal oral mucosa from healthy patients...