Oral findings as a clinical tool to differentiate between lupus erythematosus and dermatomyositis patients

Abstract

Background Dermatomyositis (DM) patients are frequently misdiagnosed as having lupus erythematosus. There are few tools to differentiate between these diseases.Objective To compare oral findings between patients with systemic lupus erythematosus (SLE), cutaneous lupus erythematosus (CLE), and DM patients to explore new clinical tools that allow differentiating between these conditions.Methods We conducted an observational, transversal, and analytical study between 2016 and 2021. One hundred sixty-seven patients were included (77 SLE, 56 CLE, and 34 DM). All patients who presented with more than one of these diseases simultaneously were excluded. All patients had a clinical evaluation of the oral cavity. We obtained photographs of the tongue, hard and soft palate, upper and lower gingiva, and jugal mucosa. Three dermatologists, blinded to the diagnosis of the diseases studied, registered the presence of the lesions of interest.Results The presence of brown pigmentation in the gingiva, whitish streaks in the jugal mucosa, palatal cobblestones, and gingival cobblestones were associated with SLE and CLE when compared with DM patients. Palatal cobblestones were present exclusively in patients with SLE and CLE. Gingival telangiectasias were associated with DM when compared with SLE, and palatal telangiectasias and well-defined palatal lesions were associated with DM when compared with SLE and CLE. Most DM patients presented palatal telangiectasias (94.12%), while this finding in SLE and CLE patients was infrequent (7.79% and 5.36%, respectively).Conclusion Oral findings can help differentiate between SLE, CLE, and DM patients when there is a diagnostic dilemma between these conditions.