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MUCOCUTANEOUS LESIONS
(VESICULOBULLOUS AND ULCERATIVE DISEASES
OF THE ORAL CAVITY)
I. INTRODUCTION
A. Location
1. Bound or unbound mucosa or both
2. Extraoral lesions
B. Morphology
1. Size of ulcer or blister - less than or more than 0.5 cm
2. Outline - round/oval or irregular, raised or flat border
3. Depth - superficial or deep
4. Solitary or multiple
5. Separate or coalescing
C. History
1. Onset - slow or rapid
2. Duration - self-limiting or persistent
3. Age of patient
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C. Herpetiform Ulceration
D. Treatment of RAU
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A. Behcet's Syndrome
C. Ulcerative Colitis
E. PFAPA Syndrome
- Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitis
- symptom complex of unknown etiology affecting primarily young children,
but may last into later childhood
- age of onset is typically prior to 5 years old
- periodic (monthly) episodes of high fever (up to 1040) lasting for 4-5
days with intervening symptom-free periods
- not associated with long-term sequelae, generally subsides or completely
resolves with time
- tx: cimetidine (Tagamet), corticosteroids, tonsillectomy & adenoidectomy
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A. Primary Herpes
B. Recurrent Herpes
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VIII. PEMPHIGUS
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IX. PEMPHIGOID
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Disseminated DLE
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IMMUNOFLUORESCENCE (IF)
Direct IF Indirect IF
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SAMPLE PRESCRIPTIONS
1-2-3 Mouthrinse
Rx: Aphthasol (amlexanox) oral paste, 5 % Rx: Dimetapp elixir 40 ml
Disp: 1 tube (5 gram) Dist H2O 80 ml Mix
Sig: Apply to affected areas q.i.d. following Kaopectate 120 ml
oral hygiene after meals and at bedtime Disp: 1 bottle
Sig: Rinse orally p.r.n.
REFERENCES
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Fine J-D. Bullous Diseases. In: Dermatology,3rd ed., Moschella SL, Hurley
HJ., eds., Philadelphia, W.B. Saunders Co., 1992, pp. 655-697.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology,
Philadelphia, 1995, pp. 128-129, 181-186, 236-241, 247-253, 559-569, 572-577,
580-583.
Dahn KA, et al. Periodic fever and pharyngitis in young children: a new
disease for the otolaryngologist? Arch Otol Head Neck Surg 2000;126:1146-
1149.
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Woo S-B, Sonis ST. Recurrent aphthous ulcers: a review of diagnosis and
treatment. JADA 1996;127:1202-1213.
HERPES SIMPLEX
ERYTHEMA MULTIFORME
PEMPHIGUS
Bystryn JC, Steinman NM. The adjuvant therapy of pemphigus. An update. Arch
Dermatol 1996;132:203-212.
Lamey P-J, et al. Oral presentation of pemphigus vulgaris and its response to
systemic steroid therapy. Oral Surg Oral Med Oral Pathol 1992;74:54-57.
PEMPHIGOID
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Lamey PJ, et. al. Mucous membrane pemphigoid. Treatment experiences at two
institutions. Oral Surg Oral Med Oral Pathol 1992;74:50-53.
Setterfield J, Shirlaw PJ, Bhogal BS, Tilling K, Challacombe SJ, Black MM.
Cicatricial pemphigoid: serial titres of circulating IgG and IgA antibasement
membrane antibodies correlate with disease activity. Brit J
Dermatol 1999;140(4):645-650.
Vodegel RM, de Jong MCJM, Pas HH, Yancey KB, Jonkman MF. Anti-epiligrin
cicatricial pemphigoid and epidermolysis bullosa acquisita: differentiation
by use of indirect immunofluorescence microscopy. J Am Acad Dermatol
2003;48:542-547.
LICHEN PLANUS
Barnard NA, et al. Oral cancer development in patients with oral lichen
planus. J Oral Pathol Med 1993;22:421-424.
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Carrizosa AM, Elorza FL, Camacho FM. Antinuclear antibodies in patients with
lichen planus. Experimental Dermatol 1997;6:54-56.
Epstein JB, Wan LS, Gorsky M, Zhang L. Oral lichen planus: progress in
understanding its malignant potential and the implications for clinical
management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:32-37.
Porter SR, et al. Immunologic aspects of dermal and oral lichen planus: a
review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:358-366.
Van der Meij EH. Et al. A review of the recent literature regarding malignant
transformation of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 1999;88:307-310.
Vincent SD, et. al. Oral lichen planus: The clincial, historical, and
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therapeutic features of 100 cases. 0ral Surg, Oral Med, Oral Pathol
1990;70:165-171.
Gammon WR, Briggaman RA. Epidermolysis bullosa acquisita and bullous systemic
lupus erythematosus: diseases of autoimmunity to type VII collagen. Dermatol
Clinics 1993;11:535-547.
Peters MS, Rogers RS. Clinical correlations of linear IgA deposition at the
cutaneous basement membrane zone. J Am Acad Dermatol 1989;20(5 Pt 1):761-770.
Beutner EH, et al. Ten cases of chronic ulcerative stomatitis with stratified
epithelium-specific antinuclear antibody. J Am Acad Dermatol 1991;781-782.
Lee LA, Walsh P, Prater CA, Su LJ, Marchbank A, Egbert TB, Dellavalle RP,
Targoff IN, Kaufman KM, Chorzelski TP, Jablonska S. Characterization of an
autoantigen associated with chronic ulcerative stomatitis: the CUSP
autoantigen is a member of the p53 family. J Invest Dermatol 1999;113(2):146-
151.
Lorenzana ER, Rees TD, Glass M, Detweiler JG. Chronic ulcerative stomatitis:
a case report. J of Periodontol 2000;71(1):104-111.
LUPUS ERYTHEMATOSUS
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DESQUAMATIVE GINGIVITIS
CINNAMON REACTION
Allen CM, Blozis GG. Oral mucosal reactions to cinnamon-flavored chewing gum.
JADA 1988;116(6:664-667.
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