Table 3. Vesicular-Ulcerated-Erythematous Surface Lesions of Oral Mucosa
|HEREDITARY – EPIDERMOLYSIS BULLOSA|
Skin lesions are always present; Nikolsky sign often present; mouth opening may be restricted due to scarring. Lesions are congenital or begin at an early age; patient frequently has a familial history.
|MYCOTIC – CANDIDOSISv(CANDIDIASIS)|
Diffuse mucosal erythema; burning or pain may be present; ulcers are rarely present; lymphadenopathy is rare. Patient often has predisposing factors: antibiotics, immunosuppression.
Slow onset; chronic lesions; exacerbations & partial remissions; lesions do not heal in a predictable period of time; lymphadenopathy is rare.
|Mucous membrane pemphigoid (cicatricial pemphigoid; benign mucous membrane pemphigoid)||Erythematous attached gingiva; vesicles sometimes observed; Nikolsky sign may be present; skin vesicles & ulcers may be present.|
|Bullous pemphigoid||Skin vesicles, bullae & ulcers are always present; occasional oral vesicles & ulcers.|
|Pemphigus||Mucosal vesicles & ulcers in any location usually precede skin lesions; Nikolsky sign may be present.|
|Lupus erythematosus||Nonspecific mucositis & ulcers are sometimes present but are associated with skin lesions.|
Oral lesions: white epithelial striae with submucosal erythema (lichenoid lesions).
Multiple organ system disorders: erythematous skin
rash, photosensitivity, arthritis, nephritis, neurologic disease; anemia, leukopenia, thrombocytopenia.
Acute onset; multiple lesions; systemic manifestations (malaise, fever, diarrhea, lymphadenopathy, lymphocytosis) often present; vesicle stage is present in all except mononucleosis.
|Herpes simplex virus:|
|Primary herpes||Vesicles & ulcers may be present anywhere in the oral cavity, pharynx, lips or perioral skin; gingiva is edematous & erythematous; lymphadenopathy is common; malaise, fever & diarrhea in some cases.|
|Recurrent herpes||Occurs on sun-exposed surfaces of lips; intraorally occurs on keratinized mucosa (dorsum of tongue, hard palate, attached gingiva); usually recurs in same location; heals in a predictable period of time for each patient.|
|Varicella (chickenpox)||Crops of pruritic papules, vesicles, ulcers on trunk spreading to arms, legs & face; mild malaise, fever & lymphadenopathy; occasional oral ulcers.|
|Herpes zoster (shingles)||Prodromal pain followed by vesicles & ulcers in the distribution of a sensory nerve; unilateral lesions; postherpetic neuralgia may occur.|
|Herpangina (Coxsackievirus A)||Vesicles & ulcers in posterior oral cavity & pharynx; may have mild systemic manifestations.|
|Hand, foot and mouth disease|
|Vesicles & ulcers of oral & pharyngeal mucosa; vesicles & macules on hands and feet; mild systemic manifestations.|
|Rubeola (measles)||Fever, conjunctivitis, photophobia, cough, nasal discharge; oral vesicles (Koplik spots); erythematous maculopapular skin rash on face spreading to trunk & extremities.|
|Epstein-Barr virus||Infectious mononucleosis: Generalized lymphadenopathy; splenomegaly; hepatomegaly; palatal petechiae; erythematous oral & pharyngeal mucosa; occasionally mucosal ulcers; no vesicular stage.|
Each disease must be considered as a separate entity.
|Aphthous ulcers||Abrupt onset of recurrent ulcers on nonkeratinized mucosal surfaces; individual ulcers heal in a predictable period of time which is variable for each patient; may be menstrually related; familial history common; “herpetiform” aphthae refer to multiple crops of small aphthous ulcers; “major” aphthae are deeper, longer lasting and more frequent ulcers which often heal with scarring.|
|Erosive lichen planus||Erythematous mucosal lesions usually with areas of ulceration; often bilateral distribution; white epithelial striae at edge of erythematous areas; atrophy of filiform papillae may be seen; chronic course.|
|Medication-induced mucositis||A variety of drugs cause mucosal lesions that do not appear to be allergic in nature; mucosal lesions consists of ulcers and erosions occurring on both keratinized & nonkeratinized mucosal surfaces.|
|Contact stomatitis||Burning, pain, ulcers, erosions, erythema sometimes covered with shaggy hyperkeratosis. Most commonly secondary to cinnamon flavoring.|
|Erythema multiforme||Sudden onset of diffuse mucosal ulcers involving buccal & labial mucosa; sometimes recurrent with variable periods of remission; skin lesions present “iris” or “target” appearance on palmar & plantar surfaces; lymphadenopathy is rare.|
|Erythroplasia (erythroplakia): epithelial dysplasia, carcinoma in situ, superficially-invasive squamous cell carcinoma||Asymptomatic, persistent, erythematous, velvety, focal to diffuse mucosal areas; more common in heavy consumers of alcohol.|