Clinical Review

Oral Lesions You Can’t Afford to Miss

Clinician Reviews. 2015 September;25(9):44-47,50-53,56

References

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ORAL SYMPTOMS MAY BE THE FIRST SIGN OF SYSTEMIC DISEASEInflammatory bowel disease. Crohn’s disease may affect the gastrointestinal tract anywhere from the mouth to the anus and may initially present with oral findings that may not correlate with abdominal symptoms. Oral Crohn’s disease may present as mucosal cobblestoning, mucosal tags, deep linear ulcerations, gingival hyperplasia, lip fissuring, aphthous ulcers, and angular cheilitis (see Figures 10 and 11). Other features may include diffuse, painless swelling of the lips and mucosal erythema.

Pyostomatitis vegetans is an uncommon condition typically associated with ulcerative colitis that is characterized by serpentine pustules that coalesce in a “snail track” pattern (see Figure 12).¹¹

Dermatologic/vesiculobullous diseases. Vesiculobullous lesions in the mouth may be seen in pemphigus vulgaris or bullous pemphigoid. Pemphigus vulgaris is an autoimmune intraepithelial blistering disease that often first presents in the oral cavity as flaccid bullae or painful ulcerations, prior to the onset of skin lesions (see Figure 13).

Mucous membrane pemphigoid is an autoimmune subepithelial disease that affects mucous membranes and the skin. Characteristic oral mucosal blisters quickly rupture and form ulcerations, which may occur in the absence of other mucosal involvement (eg, anus, genitalia, nose or throat) (see Figure 14).¹²

Painful aphthous ulcers are common. When oral ulcerations are diffuse and recurrent, they may be the first sign of Behçet’s disease, a multisystem autoimmune vasculitis.¹³

Oral lichen planus is a chronic immune-mediated mucocutaneous disease that is often limited to the oral cavity. It presents with characteristic radiating white striations of the buccal mucosa and tongue, often with associated erythema and ulcerations (see Figure 15).¹⁴

SIGNS OF SYSTEMIC DISEASE