it is not a specific disease entity , but a gingival response associated with a variety of conditions .
these desquamative lesions represent oral manifestations of various dermatoses which include lichen planus , pemphigus vulgaris , erythema multiform , lupus erythematosus , dermatitis herpetiformis , and chronic ulcerative stomatitis .
hence , it is of paramount importance to ascertain the identity of the disease responsible of desquamative gingivitis to establish the appropriate therapeutic approach and management .
this paper reports a case of rare desquamative lesion involving the gingiva in a 66-year - old female patient .
a 66-year - old female patient reported to department of periodontics , m. s. ramaiah dental college and hospital , bangalore , with the complaint of burning sensation in the gums for the past one month which had started spontaneously , not associated with pain and aggravated on taking spicy foods and relieved gradually .
she also had bleeding gums for the past one month , while brushing and eating .
her personal history reveals that she had no habits and she used medium brush with non - medicated paste . on extra oral examination , she had some obvious skin lesions on the scalp which appeared as depigmented scarring alopecia of the scalp [ figure 1 ] .
depigmentation with scarring alopecia of the scalp hyperkeratotic plaque present on the posterior auricle of the left ear intra oral examination of gingiva revealed reddish marginal , attached gingiva and interdental papilla in both maxillary and mandibular anterior region [ figure 3 ] .
desquamation of epithelium was present in the attached gingiva of maxillary right first molar region , mandibular right canine , between maxillary right premolars on the palatal aspect .
desquamation of the gingiva -maxillary and mandibular anterior region desquamation present  palatal desquamation present  lingual nikolsky 's sign - positive the h and e section showed parakeratinized stratified squamous epithelium overlying the connective tissue .
the connective tissue showed dense inflammatory infiltrate beneath the basement membrane chiefly composed of lymphocytes [ figure 7 ] .
hematological examination included total white blood cell ( wbc ) count , differential white blood count , erythrocyte sedimentation rate , hemocrit , bleeding time , and clotting time were within normal limits . based on the clinical and histopathologic features , lesion was suggestive of discoid lupus erythematosus
. hand scaling was performed as gently as possible in order to minimize tissue disruption .
hand scaling was preferred , soft tooth brush and mouth rise ( chlorhexidine 0.12% ) was recommended .
triamcinolone acteonide oral paste was advised to apply two to three times per day and was recalled for follow - up and maintenance .
lupus erythematosus is an auto immune connective tissue disease which consists of discoid lupus erythematosus ( dle ) and systemic lupus erythematosus ( sle ) .
one to five percent of patients with discoid lupus may develop systemic lupus erythematosus and 25% of patients with sle may develop typical chronic discoid lesions at some time during their illness .
early classic dle lesions typically evolve into sharply demarcated , coin shaped ( i.e. , discoid ) erythematous plaques covered by a prominent , adherent scale that extends into the orifices of dilated hair follicles .
the lesions typically expand with erythema and hyperpigmentation at the periphery leaving hallmark atrophic central scarring , telangiectasia , and hypopigmentation .
when the adherent scale is lifted from more advanced lesions , keratotic spikes similar in appearance to carpet tacks can be seen to project from the under surface of the scale ( i.e. , the  carpet tack  sign ) .
affected sites include face , scalp , ears , v area of the neck , and extensor aspects of the arms .
a symmetric , hyperkeratotic , butterfly - shaped plaque is occasionally found over the malar areas of the face and bridge of the nose .
the margins of the lesions are not sharply demarcated , but frequently show the formation of narrow zone of keratinization , hyperemia with edema , superficial , painful ulceration may occur with crusting , but no actual scale formation as is seen on the skin .
it is important to remember that patients with lupus erythematosus may be taking , systemic steroids or / and other anti - inflammatory medications such as aspirin or non steroidal anti inflammatory drugs ( nsaid 's ) consequently these patients may be at risk of developing adrenal insufficiency and bleeding disorders . in these situations ,
oral lesions may be the first clinical manifestation of dle , so proper diagnosis is required for early detection and to establish better treatment planning , this promotes resolution of established lesions and prevents scarring of skin lesions and also , alleviates discomfort of the patients .
 desquamative gingival lesions are non - plaque induced inflammatory gingival lesions . 
 it is a clinical description and not a diagnosis . 
 these desquamative lesions represent oral manifestations of various dermatoses . 
 discoid lupus erythematosus is one of the rare dermatoses which show desquamative lesions as oral manifestations . 
 this article presents a rare case report of discoid lupus erythematosus with oral lesions involving gingiva of a 66-year - old female patient . 
INTRODUCTION
CASE REPORT
DISCUSSION