The diagnosis is based on the history and the clinical features.
•Vesiculobullous diseases
•Candidiasis
•Mechanical trauma
•Thermal burns
•Erythroplakia
•Squamous cell carcinoma
Basic Guidelines
•Avoid spices, hard and hot foods.
•Mild chemical burns such as those due to alcohol, iodine, sodium hypochlorite, or sodium perborate usually heal within a week.
•More severe burns such as those caused by chlorine, trichloracetic acid, and other more caustic agents usually take up to 2 weeks to heal.
Suggested Therapies
•Usually none needed.
•In severe persistent cases oral corticosteroids in low doses for a short time. e.g., prednisone 10-15 mg/day for 3-5 days, dramatically improve the symptoms.
References
Fantasia JE, Damm DD, White mucosa. Chemical burn. Gen Dent 2001;49:265, 324.
Flaitz CM. Chemical burn of the labial mucosa and gingiva. Am J Dent 2001;14:259–260.
Milano M. Oral electrical and thermal burns in children: Review and report of case. J Dent Child 1999;66:116–119.
Mordjikian E. Severe microstomia due to burn by caustic soda. Burns 2002;28:802–805.
Nahlieli O, Eliav E, Shapira Y, Baruchin AM. Central palatal burns associated with the eating of microwaved pizzas. Burns 1999;25:465–466.
Treharne LJ, Kay AR. The initial management of acute burns. J R Arm Med Corps 2001;147:198–205.
Chronic Ulcerative Stomatitis
Chronic ulcerative stomatitis is a newly described, rare oral disease with characteristic immunofluorescent findings.
Chronic ulcerative stomatitis is an autoimmune disease with characteristic specific antinuclear antibodies directed against stratified epithelium.
The disease involves, almost exclusively, the oral mucosa and has a chronic course with recurrences.
Oral Mucosa
•Gingival lesions usually appear in the form of desquamative gingivitis
•Oral mucosal lesions (buccal mucosa and tongue) appear as painful erosions or ulcers, usually associated with white reticular lesions identical to those seen in oral lichen planus
The clinical diagnosis should be confirmed by histopathologic examination and particularly by direct and indirect immunofluorescent tests.
•Lichen planus
•Discoid lupus erythematosus
•Cicatricial pemphigoid
•Linear IgA disease
•Bullous pemphigoid
•Epidermolysis bullosa acquisita
•Pemphigus
•Oral psoriasis
•Idiopathic form of desquamative gingivitis
Basic Guidelines
•Patients with gingival involvement should avoid the use of hard toothbrushes or any mechanical friction.
•Systemic or local treatment may be used depending on the severity of the disease.
•Recurrence may occur after cessation of treatment.
Suggested Therapies
Systemic Treatment
Hydroxychloroquine
Hydroxychloroquine (Plaquenil) 200-300 mg/day is the treatment of choice for chronic ulcerative stomatitis. The lesions usually respond to treatment in 1-2 weeks and may disappear in about a month.
Oral Corticosteroids
Prednisone or prednisolone 20-40 mg/day reduce the symptoms and lesions heal in approximately 2-4 weeks. Then the dose is tapered slowly by 20% every 2 weeks. Topical corticosteroids may be used to maintain the results.
Topical Treatment
The use of 0.1 % triamcinolone acetonide in an oral adhesive base (Orabase), fluocinolone acetonide in an oral paste or 0.05% clobetasol propionate gel either alone (in mild lesions) or after control of severe lesions by systemic treatment is usually effective, particularly in cases of desquamative gingivitis. Intralesional injections of triamcinolone acetonide for extragingival lesions is also helpful.
References
Chorzelski TP, Olszewska M, Jarzabek-Chorzelska M, Jab-lonska S. Is chronic ulcerative stomaiitis an entity? Clinical and immunological findings in 18 cases. Eur J Dermatol 1998;8:261–265.
Jaremko WM, Beutner EH, Kumar V, et al. Chronic ulcerative stomatitis associated with a specific immunologic marker. J Am Acad Dermatol 1990;22:215–220.
Lewis JE, Beutner EH, Rostami R. Chorzelski TP. Chronic ulcerative stomatitis with stratified epithelium-specific antinuclear antibodies. Int J Dermatol 1996;35:272–275.
Worle B, Wollenberg A, Schaller M, et al. Chronic ulcerative stomatitis. Br J Dermatol 1997;137:262–265.
Cicatricial Pemphigoid
Cicatricial pemphigoid or mucous membrane pemphigoid is a chronic, recurrent, autoimmune blistering disease that primarily affects mucous membranes and rarely the skin. Cicatricial pemphigoid represents a heterogeneous group of diseases with respect to disease severity, clinical site of involvement, and the isotype of the associated autoantibodies.
Cicatricial pemphigoid is an autoimmune condition. Hemidesmosome and lamina lucida proteins, bullous pemphigoid antigen 180 (BP180). laminins 5, β4 integrin, and type VII collagen have been identified as the target antigens in cicatricial pemphigoid.