•Verruca vulgaris
•Papilloma
•Verruciform xanthoma
•Focal epithelial hyperplasia
•Sialadenoma papilliferum
•Molluscum contagiosum
•Focal dermal hypoplasia syndrome
•Early verrucous carcinoma
Basic Guidelines
•There is no specific antiviral therapy.
•The treatment of oral lesions should be followed by the treatment of anogenital lesions. if present.
•The oral lesions rarely recur.
•The treatment of anogenital warts must be provided by a dermatologist.
Suggested Therapies
•Conservative surgical excision of oral condyloma acuminatum is the treatment of choice—the procedure is quick and safe.
•Electrosurgery, cryotherapy, or CO2 laser may be used as alternative therapeutic measures for the treatment of oral lesions.
•Anogenital lesions are treated with a) cytotoxic agents, b) physical procedures, and c) immunomodulatory agents.
Future Therapies
Prophylactic vaccination.
References
Coremans G, Margaritis V, Snoeck R, et al. Topical cidofovir (HPMPC) is an effective adjuvant to surgical treatment of anogenital condylomata acuminata. Dis Colon Rectum 2003;46:1103–1108.
Garland SM. Imiquimod. Curr Opin Infect Dis 2003;16:85–89.
Gunter J. Genital and perianal warts: New treatment opportunities for human papillomavirus infection. Am J Obstet Gynecol 2003;189(suppl 3):S3–11.
Smith KJ, Harnza S, Skelton H. The imidazoquinolines and their place in the therapy of cutaneous disease. Expert Opin Pharmacother 2003;4:1105–1119.
Stanley MA. Progress in prophylactic and therapeutic vaccines for human papillomavirus infection. Expert Rev Vaccines 2003;2:381–389.
Tsambaos D, Georgiou S, Monastirli A, et al. Treatment of condylomata acuminata with oral isotretinoin. J Urol 1997;158:1810–1812.
Contact Cheilitis
Contact cheilitis is an acute or chronic inflammatory disorder of the lips resulting from contact with various allergens or irritants.
The most common causes are lipsticks, lip salves, toothpastes, mouthwashes, foods, etc.
•Mild edema and erythema, followed by scaling and fissures or plaques
•Dryness and a burning sensation are common
•Rarely blisters may develop
•Angular cheilitis is usually present
A careful medical history is important to determine the probable cause. Patch testing is the standard to confirm the diagnosis.
•Exfoliative cheilitis
•Plasma cell cheilitis
•Actinic cheilitis
•Herpes simplex
•Lip licking cheilitis
Basic Guidelines
•It is important to attempt to identify the causative allergen before treatment.
•Once the allergens have been identified, the patient should avoid them.
•The physician should note down information on all of the probable allergens.
Suggested Therapies
•Systemic oral corticosteroids, e.g., prednisone 20-30 mg/day for 1-2 weeks and then tapering the dose and finally stopping it in 2-3 weeks is the first-line treatment, particularly in severe cases.
•Topical corticosteroids, e.g., a low potency ointment for about 2-3 weeks may control the disease, particularly in mild cases. However, the clinician should be aware of the possibility of allergy to local corticosteroid therapy. It should be suspected when the topical treatment fails to cure the condition or an exacerbation occurs after the use of corticosteroids.
References
Boffa MJ, Wilkinson SM, Beck HM. Screening for corticosteroid contact hypersensitivity. Contact Dermatol 1995;33:149–151.
Cohen DE, Brancaccio R. What is new in clinical research in contact dermatitis. Dermatol Clin 1997;15:137–148.
Freeman S, Stephens R. Cheilitis: Analysis of 75 cases referred to a contact dermatitis clinic. Am J Contact Dermatol 1999;10:198–200.
Holmes G, Freeman S. Cheilitis caused by contact urticaria to mind flavoured toothpaste. Australas J Dermatol 2001;42:43–45.
Riera Ras P, Ras Monleon RM. Management of contact cheilitis in primary care. Aten Primaria 1998;15:53–58.
Crohn Disease
Crohn disease is a chronic granulomatous disease of the entire gastrointestinal tract.
The exact etiology of Crohn disease is unknown. However, an immune mechanism probably participates in the pathogenesis.
Oral manifestations occur in 10-30% of patients with Crohn disease. Occasionally the oral lesions precede the intestinal involvement.
Oral Lesions
•Granulomatous lip swelling
•Edematous, firm painless nodules with or without ulcerations
•Mucosal tags
•Multiple nodules resulting in a “cobblestone” pattern of the buccal mucosa
•Gingival swelling
•Angular cheilitis
•Erythema and scaling of perioral skin
•Aphthous-like lesions
•Pyostomatitis vegetans
•Regional lymphadenopathy
Abdominal