Oral discoid lupus erythematosus. I. The validity of previous histopathologic diagnostic criteria.

The histopathologic criteria set down by Lever for skin lesions of discoid lupus erythematosus (DLE) and the criteria for oral DLE suggested by the World Health Organization (WHO) have been tested on 136 biopsy specimens from oral lesions comprising 42 cases of clinically typical DLE, 24 cases of atypical DLE, 25 cases of lichen planus (LP), 25 cases of leukoplakia, 13 cases of indefinite diagnosis termed DLE? LP? and seven electrogalvanically- induced white lesions. Following studies of inter- and intraexaminer variation, the final recording was done in random order without the investigators knowing the clinical diagnosis in each case. The results showed that Lever's criteria had a high specificity for oral DLE as compared to LP and leukoplakia, but the sensitivity for clinically atypical oral DLE was rather low. The criteria established by the WHO showed no specificity for oral DLE as compared to LP. Neither the criteria by Lever nor the criteria of the WHO were specific for oral DLE as compared to electrogalvanically induced white lesions. Both sets contained criteria showing rather high inter- and intraexaminer variation. Therefore, there is a need to establish a set of histopathologic criteria showing high sensitivity and specificity for both clinically typical and atypical DLE, based on criteria showing a low inter- and intraexaminer variation.