•Bullous pemphigoid
•Linear IgA disease
•Epidermolysis bullosa acquisita
•Oral amyloidosis
•Blood dyscrasias
Basic Guidelines
•Patients should avoid hard foods.
•If the patient is using inhaled corticosteroids the patient’s internist or physician should be consulted before any treatment is prescribed.
Suggested Therapies
•Usually the lesions regress in a few days without any treatment.
•However, when multiple lesions appear, systemic oral corticosteroids, e.g., prednisone 10-20 mg/day for 1 week helps to heal the ulcerations sooner. This is important as multiple lesions may produce severe discomfort and pain.
•The use of mouthwashes with oxygen releasing agents (3 % hydrogen peroxide), is recommended for multiple lesions in connection with corticosteroids.
References
De las Heras ME, Moreno R, Nunez M, et al. Angina bullosa hemorrhagica, J Dermatol 1996;23:507–509.
Grinspan D, Abulafia J, Lanfranchi H. Angina bullosa hemorrhagica. Int J Dermatol 1999;38:525–528.
Guillor B. Skin reactions to inhaled corticosteroids. Clinical aspects, incidence, avoidance, and management. Am J Clin Dermatol 2000;1:107–111.
Stephenson P, lamey PJ, Scully C, et at. Angina bullosa hemorrhagica: clinical and laboratory features in 30 patients. Oral Surg Oral Med Oral Pathol 1987;63:560–565.
Angiocentric T-cell Lymphoma
Angiocentric T-cell lymphoma, nasal natural killer (NK)/T-cell lymphoma, malignant granuloma, or midline lethal granuloma is a rare aggressive form of lymphoma characteristically involving the midline structures of the palate and nasal cavity.
The etiology is unknown, although the Epstein-Barr virus is frequently associated with this form of lymphoma.
•Prodromal signs and symptoms, e.g., epistaxis, pain, and nasal stuffiness
•Swelling, nonhealing ulceration, and necrosis of the palate, alveolar processes, retromolar pads and the nasal cavity are common, causing destruction and perforation of the palate, nasal septum and bones
•Secondary infections and hemorrhage usually complicate the course of the disease
The clinical diagnosis should be confirmed by biopsy and histopathologic examination and immunohistochemical evaluation.
•Wegener granulomatosis
•Non-Hodgkin lymphoma
•Squamous cell carcinoma
•Necrotizing sialadenometaplasia
•Mucormycosis
•Other multiple mycoses
•Leprosy
•Syphilitic gumma
Suggested Therapies
•High-dose radiation therapy is the treatment of choice, in particular, of localized early disease. The lesion usually responds well to this treatment and recurrences are rare.
•Chemotherapy alone or in combination with radiation must be used for aggressive and disseminated disease. The prognosis of this form is unfavorable.
References
Koch M, Blatterspiel GJ, Niedobitek G, Konstantinidis J. Angiocentric T/NK cell lymphoma: A special clinical-pathological entity of lethal midline granuloma. A case report. Laryngorhinoolologie 2001;80:410–415.
Lee PY, Freeman NJ, Khorsand J, et al. Angiocentric T-cell lymphoma presenting as lethal midline granuloma. Int J Dermatol 1997;36:419–427.
Mosqueda-Taylor A, Meneses-Garcia A, Zarate-Osorno A. et al. Angiocentric lymphomas of the palate: Clinico-pathological consideration in 12 cases J Oral Pathol Med 1997;26:93–97.
Torre V, Bucolo S, Galletti B, Cavallari V. Midfacial granuloma syndrome or an inflammatory non-specific disease? J Oral Pathol Med 2001;30:190–192.
Vidal E, Dean A, Alamillos F, et al. Lethal midline granuloma in a human immunodeficiency virus-infected patient. Am J Med 2001;111:244–245.
Angular Cheilitis
Angular cheilitis or perlèche is a common inflammatory disorder of the corners of the mouth.
Angular cheilitis has a multifactorial etiology. Systemic diseases (anemia, diabetes mellitus, human immunodeficiency virus [HIV] infection), xerostomia, habitual licking of the corners of the mouth, reduced vertical dimension of the face, and local infection by Candida albicans. Staphylococcus aureus and streptococci are the most common causes.
•Maceration, erythema, fissuring, erosions, and crusting at the commissures
•Saliva tends to pool at the corners of the mouth, keeping them moist and favoring Candida and bacterial infection
•Lesions are usually painful
The diagnosis is based on the clinical features.
Basic Guidelines
•Before any topical treatment the presence of a systemic disease should be ruled out. In cases with an underlying disease, control of the disease improves the angular cheilitis as well.
•If loss of vertical dimension is the cause it must be corrected by the dentist.
Suggested Therapies
•Application of a topical ointment with corticosteroids, antimycotics. and antibacterial agents, two to three times daily for 1-2 weeks improves the condition dramatically.
•Topical treatment with nystatin or imidazole ointment is helpful but not always curative.
•Systemic triazoles, e.g., itraconazole capsules 100 mg/day for 6 days or more, are necessary if oral candidiasis is diagnosed.