Liu Z, Diaz LA. Bullous pemphigoid: End of the century overview. J Dermatol 2001;28:647–650.
Stern RS. Bullous pemphigoid therapy—think globally, act locally. N Engl J Med 2002;346:364–367.
Wojnarowska F, Kirtschig G, Khumalo N. Treatment of sub-epithelial immunobullous diseases. Clin Dermatol 2001;19:768–777.
Burkitt Lymphoma
Burkitt lymphoma is a high-grade malignancy of B-lymphocyte origin that usually affects the jaws.
Epstein-Barr virus has been implicated in the pathogenesis of Burkitt’s lymphoma.
There are three types of Burkitt lymphoma: a) African, b) endemic, and c) American or sporadic.
•Pain, tenderness, paresthesia, bone destruction, and tooth mobility and loss are common symptoms and signs
•A large ulcerating or nonulcerating soft tissue mass may also be present in the oral mucosa and gingiva
•The maxilla is more frequently affected than the mandible
•Usually affects children 2-12 years of age
The clinical diagnosis should be confirmed by a biopsy and histopathologic examination.
•Non-Hodgkin lymphoma
•Osteosarcoma
•Chondrosarcoma
•Ewing’s sarcoma
•Multiple myeloma
•Cherubism
•Central giant cell granuloma
•Odontogenic tumors
•Chemotherapy—CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimens or more complex chemotherapy-is the treatment of choice, either alone or in combination with radiotherapy and surgery. This regimen has improved the prognosis of Burkitt lymphoma.
•Radiation therapy is the second treatment choice, either alone or in combination with chemotherapy.
•Surgery can also be used for early localized lesions.
References
Hesseling PB, Broadhead R. Molyneux E, et al. Malawi pilot study of Burkitt lymphoma treatment. Med Pediatr Oncol 2003;41:532–540.
Levine AM. Challenges in the management of Burkitt’s lymphoma. Clin Lymphoma 2002;3(suppl 1):S19-S25.
Philip T, Bergeron C. Burkitt’s lymphoma: A model for pediatric oncology. Arch Pediatr 2000;7:924–926.
Shapira J, Peylan-Ramu N. Burkitt’s lymphoma. Oral Oncol 1998;34:15–23.
Wang ES, Straus DJ, Teruya-Feldstein J. et al. Intensive chemotherapy with cyclophosphamide, doxorubicin, high-dose methotrexate-ifosfamide, etoposide. and high-dose cytarabine (CODOX-M/IVAC) for human immunodeficiency virus-associated Burkitt’s lymphoma. Cancer 2003;98:1196–1205.
Weinthal JA, Goldman SC, Lenarsky C. Successful treatment of relapsed Burkitt’s lymphoma using unrelated cord blood transplantation as consolidation therapy. Bone Marrow Transplant 2000;25:1311–1313.
Candidiasis
Candidiasis is the most frequent fungal infection of the oral cavity.
Candida albicans is the most common Candida species to cause oral candidiasis. Other species such as C. glabrata. C. tropicalis, C. krusei, C. parapsilosis, C. dubliniensis can cause infections though less frequently. Candida species are normally present on mucocutaneous body surfaces, and several local and systemic predisposing factors are necessary to develop infection with clinical symptoms and signs.
Oral candidiasis is clinically classified as primary and secondary. Primary candidiasis includes several clinical forms such as pseudomembranous, erythematous, nodular, and Candida-associated lesions (angular cheilitis, median rhomboid glossitis, denture stomatitis). Secondary candidiasis includes chronic mucocutaneous and Candida-endocrinopathy syndrome. Systemic candidiasis is less common than superficial Candida infection, but it is an increasing problem in immunocompromised patients. Candidemia is now recognized as the fourth most important nosocomial bloodstream infection.
The oral mucosa is the most common site of superficial candidiasis. However, the vagina, glans penis, skin, and nails may also be involved.
Pseudomembranous (Thrush)
•The most common form of oral candidiasis, usually acute. It appears as creamy whitish spots or plaques, which usually can be detached. The lesions may be localized or generalized. Burning, dryness, loss of taste, and pharyngeal dysphagia are common symptoms
Erythematous
It appears as erythematous patches usually on the dorsum of the tongue and palate. This form is common in HIV-infected patients and in patients on antibiotics. Burning is a common symptom
Nodular
A chronic form of candidiasis that appears as white, firm, raised plaques that cannot be detached. The lesions are usually asymptomatic
Candida-Associated Lesions
Angular cheilitis: red, fissured crusts with or without erosions. Whitish spots or plaques may be present
Median rhomboid glossitis: reddish smooth or nodular surface on the midline of the dorsum of the tongue
Denture stomatitis: diffuse erythema and edema of the mucosa underneath a denture
Secondary Forms
Chronic mucocutaneous candidiasis: chronic oral lesions, skin and nail lesions as well. Classically the oral lesions are generalized Candida-endocrinopathy syndrome: severe oral. skin, and nail lesions associated with endocrinopathies appear early in life from 4-6 years of age
The diagnosis of candidiasis is usually based on clinical criteria. Direct smear microscopic examination with potassium hydroxide and culture are helpful. Biopsy and histopathologic examination may also be useful in some cases.