Pathology · patient case question
A patient presents with a raised erythematous rash across the cheeks and bridge of the nose. This is most characteristic of:
Patient case: Two white lesions and a brown one
demo: Three patients seen in one session
chief: Assorted mucosal lesions identified during routine examination.
history: The first is a 24-year-old with a lifelong asymptomatic finding whose brother has the same appearance. The second is a 41-year-old with bilateral buccal findings. The third is a 52-year-old who has chewed betel nut for twenty years.
meds: None relevant.
findings: Patient one has a diffuse, thick, spongy, folded white lesion of the floor of the mouth and buccal mucosa that does not rub off. Patient two has a diffuse blue-grey filmy opacity of both buccal mucosae that fades when the cheek is stretched. Patient three has brownish-red clustered staining of the buccal mucosa near teeth 18 and 19 with a marbled pallor and reduced mouth opening.
Show answer and explanation
Correct answer: C. Systemic lupus erythematosus
- A. Rosacea produces central facial erythema with telangiectasia and papulopustules, and it does not spare the nasolabial folds in the characteristic butterfly pattern.
- B. Contact dermatitis follows the pattern of exposure to an allergen and would not respect this symmetrical malar distribution.
- C. Correct. The malar or butterfly rash spans both cheeks and the nasal bridge while sparing the nasolabial folds, and is one of the classification criteria for SLE. Oral findings include palatal ulceration and lichenoid lesions, and patients may carry secondary Sjogren, antiphospholipid antibodies or be taking immunosuppressants that affect dental care.
- D. Seborrhoeic dermatitis gives greasy scaling in the nasolabial folds, eyebrows and scalp, which is close to the opposite distribution.