Butterfly rash with periodontitis: A diagnostic dilemma
A 40 year old female reported to the Department of Periodontics, Institute of Dental Sciences, Bareilly, with the chief complaint of swelling and bleeding from gums associated with burning sensation since last two years and bright red discoloration of the skin involving the malar region bilaterally, bridge of nose and chin. Patient gave history of severe itching on the discolored region.\nThe medical and family history was non-contributory.\nExtraoral examination revealed malar rash involving the chin accompanied by yellowish white pustules scattered along the discoloration. The discoloration appeared first on cheeks, followed by nose and finally the chin as shown in Figure , , , , . The discoloration was followed by acne, followed by pustules and finally the scar which healed by itself followed by its reappearance after 10-15 days.\nIntraoral examination revealed bright red discoloration of the gingiva involving the marginal, interdental and attached gingiva extending from #14 to 22 and #43 to 31 and mild generalized inflammatory enlargement was noticed [].\nDetailed history from the patient revealed that the bleeding from gingiva was insidious, mild, intermittent, occurred only while brushing the teeth and aggravated on eating hard fruits. The swelling of gingiva was first noticed by the patient about 2 years back. It appeared first in the interdental region and then progressed to involve the other parts of gingiva. Swelling increased in size gradually, decreased thereafter two months for about 15 days, then regains its original size.\nRadiographic findings [] showed features of chronic generalized periodontitis with horizontal pattern of bone loss and angular defect at some sites.\nLaboratory investigations carried out included routine blood investigations, LE cell phenomenon, ANA studies (antinuclear antibody studies), anti ds DNA (anti double stranded DNA). All values were found to be within normal limits.