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  • Essay / Lupus Erythematosus: Case Analysis

    Table of ContentsCase ReportDiscussionReferencesLupus is a chronic autoimmune disease that damages any part of the body, such as the skin, joints, or any part of the interior of the body. Autoimmune diseases mean that our immune response cannot differentiate foreign invaders from healthy body tissues. Thus the body creates autoantibodies which will attack healthy tissues in the body. Most of those affected are women, as 9 out of 10 people with lupus are women. It usually develops in women aged 15 to 45. It can be difficult to distinguish lupus from another disease because it can mimic many other diseases and symptoms often develop slowly because no pattern can be detected. It can also come and go. Early detection is always the best way to reduce the progression and severity of the disease. Lupus can be caused by a few factors such as genes, environment and hormones. There is no scientifically proven gene that causes lupus, but the incidence of lupus in a family member gives rise to the idea that genes contribute to lupus disease. Lupus can also be triggered by certain environmental factors such as UV rays from the sun, antibiotics like penicillin, sulfa drugs that make a person more sensitive to the sun, infection, injury or even a cold or viral illness. Regarding hormones, sex hormones can play a role in the development of lupus, particularly estrogen. This hormone is produced by both men and women, but production is high in women, which may indicate the severity of lupus. Lupus is classified into three different types: Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get the original essay Systemic lupus erythematosus (SLE), still called lupus. It is a systemic disease, meaning it can affect many types of organs or parts of the body. A person with SLE may experience mild to severe symptoms. Discoid lupus erythematosus only affects the skin. A person will have a red, raised rash on the face, scalp, or elsewhere. These areas will become thick and scaly. Drug-induced lupus which refers to lupus caused by the use of medications. Usually, symptoms disappear after stopping treatment. Case Report A 70-year-old woman was reported to the periodontology department of Adesh Institute of Dental Sciences and Research with the chief complaint of dry mouth, fever and generalized redness of the gums with associated burning sensation. in the gum for a month which had started spontaneously. She also complained of bleeding gums over the past month while brushing her teeth and eating. Her medical history revealed that she had been diagnosed with systemic lupus erythematosus approximately 10 years ago. His vital signs were monitored and found to be normal. Clinical examination revealed a depigmented malar rash on the facial skin. His laboratory examination showed a white blood cell count of 2300 (neutrophils 30%, lymphocytes 45%, monocytes 25%), an elevated ESR, and a normal urinalysis. Intraoral examination revealed the presence of marginal, attached, erythematous gingiva and an interdental papilla in the anterior maxillary and mandibular region. Nikolsky's sign was positive. Generalized hemorrhage on probing was positive; however, no periodontal pockets or furcation involvement were observed. The clinical diagnosis was established byincisional biopsy, performed under local anesthesia. Histological examination reveals findings consistent with SLE. The management of this patient in the periodontics department therefore consists of scaling as gently as possible and advising to maintain oral hygiene. He was prescribed a soft-bristled toothbrush with triamcinolone acteonide oral paste and chlorexhidine mouthwash. A 68-year-old man presented with a complaint of non-healing oral ulcers for 6 months associated with pain and burning sensation. The gradual onset associated with erythema and burning sensation followed by blisters which ruptured within 2 to 3 days led to ulceration of the area. There was no prodromal fever or malaise. Initially, lesions were noted on the dorsum of the tongue, followed by damage to the palate and the oral and labial mucous membranes associated with swallowing difficulties. Two months later, he noticed similar lesions on the skin, mainly on the trunk and scalp regions, which healed in 7 to 14 days. The patient is in a skin consultation and is currently taking topical corticosteroids and anticandidate mouthwashes. The skin lesion showed signs of healing but persistent intraoral lesion. Medical history revealed that the patient has been diabetic for 14 years and is taking medication. Family history is not significant. The patient was malnourished and weak with signs of pallor. Examination of the trunk revealed multiple well-defined, roughly round, erosive lesions measuring approximately 1x2 cm in size. Head and neck examination showed discrete erosive lesions on the cheek, nose and scalp measuring approximately 0.5 x 1 cm in diameter. Scalp lesions causing scarring. Bilateral submandibular lymph nodes are palpable, single, tender, firm, mobile, and measure 1 cm in diameter. Intraoral examination revealed a restricted and painful mouth opening with multiple discrete superficial ulcerations along the upper and lower oral mucosa, labial mucosa, soft palate, and vestibule. . Diffuse, irregular ulcers covered with pseudomembranous desquamation were noted. On palpation, ulcers are tender and bleed upon slight provocation. Multiple fibrous bands are felt along the bilateral and circumoral oral mucosa. The tongue appears depapilated, with areas of fissures and erythema. Hard tissue examination revealed poor periodontal health, with widespread mobility and attrition of the teeth. A histopathological section was obtained from the incisional biopsy of a skin lesion revealing epidermal hyperkeratosis and focal keratotic plugging. We can also observe a slight atrophy of the layer malphigii and a slight degeneration of the basal layer. This suggests DLE as the dermis showed mild edema and some scattered aggregates of chronic mononuclear inflammatory cells in the form of lymphocytes and plasma cells. The treatment given to this patient at the first visit consisted of topical antibiotics and analgesics as well as multivitamins. antioxidant supplement and protein, topical corticosteroid was administered for skin lesions. Follow-up was done after 5 days. A 19-year-old patient, working as a farmer, mainly complained of a painful ulcer on the lower lip for 6 months. The nature of the pain was of insidious onset, localized stabbing or stinging, of moderate intensity, aggravated by food intake or by trauma to this region. The ulcers were initially small andgradually progressed to their present size with the incidence of white serous discharge. The lymph nodes were not palpable. A systemic assessment has been carried out and there is no significant evidence to support this. The patient had a class 3 facial profile with lower lip protrusion. Two discrete oval-shaped ulcers measuring 1 cm x 1 cm with regular borders with the thin marginal area of ​​erythema. There was a presence of radiant streaks originating from the area of ​​erythema. Considering the oral manifestation, a provisional diagnosis for mixed white and red lesions was made. The differential diagnosis was DLE actinic keratosis and minor erythema multiforme. The treatment administered was systemic and topical corticosteroid therapy for 21 days. The patient was advised to cover his mouth with a soft cloth when going to the fields. It is reaffirmed that the diagnosis of SLE is based on clinical presentation, nature of the lesion and response to treatment. DiscussionSystemic lupus erythematosus is an autoimmune disease that is accompanied by numerous cutaneous and oral manifestations. As mentioned earlier, the disease attacks whenever the body produces autoantibodies against many of its cells, cellular components, and tissues. Hormone and gender play a vital role in SLE, as it is more common in women and always correlates with the production of estrogen and progesterone. The LED often appears without a diagram. Clinically, lupus is a disease with an unpredictable course, involving flares and remissions, where the longer it progresses, the more damage it causes to the body. Common symptoms that may occur in a person with SLE are extreme fatigue, headache, fever. , swelling of the joints, anemia, chest pain when breathing deeply, butterfly-shaped rash on the cheek and nose, sensitivity to sun or light, hair loss, abnormal blood clotting, and ulcers of the mouth and nose. Mucosal involvement, as in patients with SLE, is common. It usually manifests as well-demarcated erythema or erosion with white central papules surrounded by white radiant streaks. A study was performed on oral findings in patients attending the multidisciplinary lupus clinic between January 2015 and April 2016. Results indicate that most patients are female (88%) and have been diagnosed with SLE (62% ), 26% suffered from SLE. Half of the patients had positive oral findings, 26% had no documented oral examination, and 24% had a documented oral examination. The most common site of oral finds is the palace. Then at the level of the labial mucosa, the oral mucosa, the gum and the alveolar ridge. Oral manifestations suggestive of lupus were erosions or ulcers (5 cases), erythema in 4 cases and white plaque in 4 cases. In this cohort study, it is normal to detect oral pathology and it is mandatory to perform oral examination to identify oral lupus and provide treatment. Fabri et al revealed that treatment of periodontal disease is beneficial in controlling disease activity in SLE patients with immunosuppressive therapy. . A recent study also indicated that periodontal treatment may be helpful in reducing SLE symptoms. DLE is a type of lupus erythematosus that is usually limited to the skin and has minimal systemic involvement. Lesions usually appear as erythematous, edematous, scaly papules that spread from.38