Oral lesions: Difference between revisions
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== Overview == | == Overview == | ||
In many cases, mouth sores are attributed to [[herpes simplex virus]] and idiopathic [[aphthous stomatitis]]. Oral lesions can be indicative of a more serious underlying condition. A full review of the systems and a full skin exam are necessary to obtain an accurate diagnosis. | In many cases, mouth sores are attributed to [[herpes simplex virus]] and idiopathic [[aphthous stomatitis]]. Oral lesions can be indicative of a more serious underlying condition. A full review of the systems and a full skin exam are necessary to obtain an accurate diagnosis. | ||
== Differential diagnosis of oral cavity lesions == | |||
== Oral Involvement<small><small> === | |||
<div style="width: 70%;"> | |||
{| class="wikitable" | |||
!Disease | |||
!Presentation | |||
!Risk Factors | |||
!Diagnosis | |||
!Affected Organ Systems | |||
!Important features | |||
!Picture | |||
|- | |||
! colspan="3" |Diseases predominantly affecting the oral cavity | |||
! | |||
! | |||
! | |||
! | |||
|- | |||
|[[Oral candidiasis|Oral Candidiasis]] | |||
| | |||
* [[Dysphagia]] or [[odynophagia]] | |||
* White patches on the mouth and tongue | |||
| | |||
*[[Newborn]] babies | |||
*Denture users | |||
*Poorly controlled [[diabetes]] | |||
*As a side effect of medication, most commonly having taken [[antibiotic]]s. Inhaled [[corticosteroids]] for the treatment of lung conditions (e.g, [[asthma]] or [[COPD]]) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication. | |||
*People with poor [[nutrition]], specifically [[vitamin A]], [[Iron deficiency anemia|iron]] and [[Folate deficiency|folate deficiencies]]. | |||
*People with an [[immune deficiency]] (e.g. as a result of [[AIDS]]/[[HIV]] or [[chemotherapy]] treatment). | |||
*Women undergoing hormonal changes, like [[pregnancy]] or those on [[birth control pills]]. | |||
*[[Organ transplantation]] patients | |||
| | |||
* Clinical diagnosis | |||
* Confirmatory tests rarely needed | |||
|'''Localized candidiasis''' | |||
* [[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]] | |||
* [[Candida vulvovaginitis]] | |||
* [[Chronic mucocutaneous candidiasis]] | |||
'''Invasive candidasis''' | |||
* [[Candidiasis|Candidaemia]] | |||
* [[Endocarditis|Candida endocarditis]] | |||
* [[Osteoarthritis|Candida osteoarticular disease]] | |||
| | |||
* [[Osteoarthritis|Oral candidiaisis is]] a benign self limiting disease unless accompanied by [[immunosuppression]]. | |||
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]] | |||
|- | |||
|[[Herpes simplex|Herpes simplex oral lesions]] | |||
| | |||
* [[Fever]] | |||
* [[Sore throat]] | |||
* Painful [[ulcer]]s | |||
| | |||
* Stress | |||
* Recent [[URTI]] | |||
* Female sex | |||
| | |||
* Physical examination | |||
* [[Viral culture]] | |||
* [[Tzanck smear]] | |||
| | |||
* Orofacial Infection | |||
* [[Herpes simplex anogenital infection|Anogenital Infection]] | |||
* [[Herpes simplex ocular infection|Ocular Infection]] | |||
* [[Herpes simplex encephalitis|Herpes Encephalitis]] | |||
* [[Herpes simplex neonatorum|Neonatal Herpes]] | |||
* [[Herpetic whitlow|Herpetic Whitlow]] | |||
* [[Herpes gladiatorum|Herpes Gladiatorum]] | |||
| | |||
* The symptoms of primary [[HSV]] infection generally resolve within two weeks | |||
|[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]] | |||
|- | |||
|[[Aphthous ulcer|Aphthous ulcers]] | |||
| | |||
* Painful, red spot or bump that develops into an open [[ulcer]] | |||
| | |||
* Being a female | |||
* Between the ages of 10-40 | |||
* Family history of [[Aphthous ulcer|aphthous ulcers]] | |||
| | |||
* Physical examination | |||
* Diagnosis of exclusion | |||
| | |||
* Oral cavity | |||
| | |||
* Self-limiting , [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks | |||
|[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the under surface of the tongue|By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358|400x400px]] | |||
|- | |||
|[[Squamous cell carcinoma]] | |||
| | |||
*Non healing [[ulcer]], [[nodule]], indurated plaque or mass | |||
*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]] | |||
| | |||
* Chronic sun or [[Ultraviolet|UV exposure]] | |||
* Fair [[skin]] | |||
* [[Elderly]] age (>45 yrs) | |||
* [[Male sex]] | |||
* [[Smoking]] | |||
| | |||
*[[Physical exam]] | |||
*[[Biopsy]] | |||
| | |||
*[[Oral Cavity]] | |||
**Floor of [[mouth]] | |||
**Lateral [[tongue]] | |||
*[[Throat]] | |||
*[[Esophagus]] | |||
| | |||
*[[Malignant]] | |||
*Can spread to [[TMJ]] | |||
*Some times associated with [[leukoplakia]] | |||
|[[File:Squamous cell carcinomaa.jpg|Squamous cell carcinoma|400x400px]] | |||
|- | |||
|[[Leukoplakia]] | |||
| | |||
*White leathery spots on the [[mucous membranes]] of the [[tongue]] and inside of the [[mouth]] | |||
*Lateral borders of [[tongue]] | |||
| | |||
*Atypical [[Tobacco]] use | |||
*Chronic [[irritation]] | |||
*[[Immunodeficiency]] | |||
*[[Bloodroot]] ([[Sanguinarine|sanguinaria]]) | |||
| | |||
*[[Physical exam]] | |||
*Diagnosis of exclusion | |||
*[[Biopsy]] | |||
| | |||
*[[Vulva|Vulvar]] lesions occur independent of oral lesions | |||
| | |||
*Associated with [[HIV]] | |||
*Persistant white spots | |||
*[[Benign]] but can progress to [[carcinoma]] after almost 10 years | |||
*Oral proliferative [[Leukoplakia|verrucous leukoplakia]] is an aggressive sub type with multiple lesions and higher conversion to [[warts]] or [[carcinoma]] | |||
|[[File:Oral hairy leukoplakia (EBV, in HIV)a.jpg|Leukoplakia|400x300px]] | |||
|- | |||
|[[Melanoma]] | |||
| | |||
*A lesion with [[ABCD]] | |||
**[[Asymmetry]] | |||
**Border irregularity | |||
**Color variation | |||
**[[Diamete]]r changes | |||
*[[Bleeding]] from the lesion | |||
| | |||
*[[Ultraviolet|UV radiations]] | |||
*[[Genetic predisposition]] | |||
*[[Old age]] | |||
*[[Male gender]] | |||
*Family or personal history of [[melanoma]] | |||
*Multiple benign or atypical [[Nevus|nevi]] | |||
| | |||
*[[ABCD]] characteristics | |||
*[[Bleeding]] or [[ulceration]] may show [[malignancy]] | |||
*Serum [[LDH]] may be elevated in case of [[malignancy]] | |||
*[[Biopsy]] | |||
| | |||
*Can [[metastasize]] | |||
*All [[UV radiation]] or sun exposed areas can be effected independently | |||
*1-2 to hundreds of [[granules]] | |||
| | |||
*[[Neural crest cell]] derivative | |||
*Development begins with disruption of [[nevus]] growth control | |||
*Progression involves [[MAPK/ERK pathway]] | |||
*[[RAS|N-RAS]] or [[BRAF]] [[oncogene]] also involved | |||
|[[File:Melanoma oral 001a.jpg|Oral melanoma|400x400px]] | |||
|- | |||
|[[Fordyce spots]] | |||
| | |||
*Rice-like [[granules]] or [[spots]] | |||
*Small, [[painless]], [[raised]], [[pale]], red or white | |||
*1 to 3 mm in [[diameter]] | |||
| | |||
*Greasy skin types | |||
*Some [[Rheumatic|rheumatic disorders]] | |||
*[[Hereditary nonpolyposis colorectal cancer]] | |||
**Lower [[gingiva]] (gums) | |||
**[[Vestibular system|Vestibular mucosa]] | |||
| | |||
*[[Physical exam]] | |||
*Small [[keratin]]-filled [[pseudocysts]] | |||
*May be seen on [[incidental]] [[mucosal]] [[biopsy]] | |||
**[[Biopsy]] not done for them primarily | |||
| | |||
*[[Oral cavity]] | |||
**[[Vermillion border|Vermilion border]] of the lips | |||
**[[Oral mucosa]] of the upper lip | |||
*[[Buccal mucosa]] in the commissural region often bilaterally | |||
*[[Genitals]] | |||
| | |||
*[[Benign neoplasms]] with [[sebaceous]] features | |||
*Visible [[sebaceous glands]] | |||
*No surrounding [[mucosal]] change | |||
*Several adjacent [[glands]] may coalesce into a larger cauliflower-like cluster | |||
|[[File:Fordyce spots 02a.jpg|Fordyce spots|400x400px]] | |||
|- | |||
|[[Burning mouth syndrome]] | |||
| | |||
*Burning or [[tingling]] on the [[lips]], [[tongue]], or entire [[mouth]] | |||
| | |||
*[[Nutritional deficiencies]] | |||
*Chronic [[anxiety]] or [[depression]] | |||
*[[Diabetes type 2]] | |||
*[[Menopause]] | |||
*[[Oral thrush]] or [[dry mouth]], or damaged [[nerves]] transmitting taste | |||
*[[Female gender ]] | |||
*[[Menopause]] | |||
| | |||
*[[Presentation]] | |||
*[[Physical exam]] | |||
| | |||
*[[Oral cavity]] | |||
| | |||
*Pain typically is low in the morning and builds up over the day | |||
*Low dosages of [[benzodiazepines]], [[tricyclic antidepressants]] or [[anticonvulsants]] may be effective | |||
| | |||
|- | |||
|[[Torus palatinus]] | |||
| | |||
*Bony growth on midline of the [[hard palate]] | |||
*[[Nodular]] mass covered with normal [[mucosa]] | |||
| | |||
*[[Genetic predisposition]] | |||
**[[Autosomal dominant]] | |||
| | |||
*[[Physical exam]] | |||
*Types | |||
**[[Torus palatinus|Flat tori]] | |||
**[[Torus palatinus|Spindle tori]] | |||
**[[Torus palatinus|Nodular tori]] | |||
**[[Torus palatinus|Lobular tori]] | |||
| | |||
*[[Hard palate]] | |||
| | |||
*More common in [[Asian]] and Inuit populations | |||
*Twice more common in [[females]] | |||
*Repeated [[trauma]] can cause [[bleeding]] | |||
*[[Surgery]] may be required in symptomatic | |||
|[[File:06-06-06palataltoria.jpg|Torus palatinus|400x400px]] | |||
|- | |||
| colspan="4" |'''Diseases involving oral cavity and other organ systems''' | |||
| | |||
| | |||
| | |||
|- | |||
|[[Behçet's disease|Behcet's disease]] | |||
| | |||
*Painful [[mouth sores]] | |||
*[[Acne]] like skin lesions | |||
*Headache, [[fever]], poor [[balance]], [[disorientation]] | |||
*[[Abdominal pain]], [[diarrhea]] or [[bleeding]] | |||
*[[Uveitis]] | |||
*Joint [[swelling]] and joint [[pain]] | |||
*Genital [[sores]] wit [[pain]] and [[scaring]] | |||
*[[Aneurysms]] | |||
| | |||
*Over active [[immune system]] | |||
| | |||
*[[Physical examination]] | |||
| | |||
*[[Mouth]] | |||
*[[Genitals]] | |||
*[[GIT]] | |||
*[[Eye]] | |||
*[[Joints]] | |||
*[[Skin]] | |||
*[[Vascular system]] | |||
*[[Brain]] | |||
| | |||
*[[Outbreaks]] of exaggerated [[inflammation]] | |||
*Affects smaller [[blood vessels]] | |||
|[[File:Behcet's syndrome 11a.jpg|Behcet's disease|400x400px]] | |||
|- | |||
|[[Crohn's disease]] | |||
| | |||
*Chronic, episodic [[diarrhea]] or [[constipation]] | |||
*[[Abdominal pain]] | |||
*[[Vomiting]] | |||
*[[Weight loss]] or [[weight gain]] | |||
| | |||
*[[Smoking]] | |||
*[[Whites]] and [[European]] [[Jews]] | |||
*[[Hormonal contraception]] | |||
*Diets high in microparticles, sweet, fatty or refined foods | |||
*Industrialized country | |||
| | |||
*Typical [[history]] and [[symptoms]] | |||
*[[Skip lesions]] on [[biopsy]] | |||
*[[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies (ASCA)]] | |||
*[[Anti-neutrophil cytoplasmic antibodies]] ([[ANCA]]) | |||
| | |||
*[[Eyes]] | |||
*[[Joints]] | |||
*[[Skin]] | |||
| | |||
*May lead to | |||
**[[Obstruction]]s | |||
**[[Abscess]]es | |||
**Free [[perforation]] | |||
**[[Hemorrhage]] | |||
| | |||
|- | |||
|[[Agranulocytosis]] | |||
| | |||
*[[Fever]] or [[chills]] | |||
*Frequent [[infections]] | |||
*Unusual [[redness]], [[pain]], or [[swelling]] around a wound | |||
*Mouth [[ulcers]] | |||
*[[Abdominal pain]] | |||
*[[Burning sensation when urinating]] | |||
*[[Sore throat]] | |||
| | |||
*[[Medications]] | |||
*[[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]] | |||
*[[Hematological malignancy|Hematologic malignancies]] | |||
*[[Autoimmune disorders]] | |||
| | |||
*[[Neutropenia]] <100 cells per micro litre | |||
*[[Eosinopenia]] | |||
*[[Basopenia]] | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
*[[GIT]] | |||
*[[Urinary system]] | |||
*[[Conjunctiva]] | |||
| | |||
*[[Immunocompromised|Immunocompromization]] | |||
*Types | |||
**[[Drug-induced]] | |||
**[[Malignant]] | |||
**[[Autoimmune]] | |||
| | |||
|- | |||
|[[Syphilis]] | |||
| | |||
*[[Chancre]] | |||
*Regional [[lymphadenopathy]] | |||
| | |||
*[[Multiple sexual partners]] | |||
*Illicit [[drug use]] | |||
*[[Unprotected sex]] | |||
*[[Homosexual men|Men who have sex with men]] | |||
*Residence in highly prevalent areas | |||
*[[Human Immunodeficiency Virus (HIV)|HIV]] infection | |||
*Presence of other [[STI]]s | |||
*Previous history of [[Sexually transmitted disease|STIs]] | |||
*[[Intravenous drug use]] | |||
| | |||
*[[Darkfield microscope|Darkfield microscopy]] | |||
*Non [[Treponema|treponemal]] tests like [[VDRL]] and [[RPR test]]) | |||
*[[Treponema|Treponemal]] tests[[FTA-ABS|FTA-ABS tests]], (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]) | |||
| | |||
*[[Oral cavity]] | |||
*[[Penis]] | |||
*[[Cervix]] | |||
*[[Labia]] | |||
*[[Anal canal]] | |||
*[[Rectum ]] | |||
*[[CNS]] | |||
*[[Cardiovascular|CVS]] | |||
| | |||
*[[Primary syphilis]] | |||
**[[Chancre]] | |||
*[[Secondary syphilis]] | |||
**[[Condyloma latum|Condylomata lata]] | |||
*[[Latent syphilis]] | |||
**[[Asymptomatic]] | |||
*[[Tertiary syphilis]] | |||
**[[Gumma|Gummas]] | |||
**[[Neurosyphilis]] | |||
|[[File:Syphilis orala.jpg|oral syphilis|400x400px]] | |||
|- | |||
|[[Coxsackie virus]] | |||
| | |||
*[[Fever]] | |||
*[[Sores]] in the [[mouth]] | |||
*[[Rash]] with [[blisters]] | |||
*[[Aches]] | |||
| | |||
*[[Pregnancy]] | |||
*[[immunodeficiency]] | |||
| | |||
*[[History]] and [[Physical exam]] | |||
*[[Swabbing|Throat swabs]] | |||
*Swabs from the lesion | |||
*[[Tzanck test]] | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
| | |||
*Symptomatic treatment | |||
|[[File:Hand foot mouth disease 07a.jpg|Hand-foot-and-mouth disease|400x400px]] | |||
|- | |||
|[[Chickenpox|Chicken pox]] | |||
| | |||
*[[Conjunctival]] symptoms | |||
*[[Catarrhal]] symptoms | |||
*Characteristic [[spots]] on the trunk appearing in two or three waves | |||
*[[Itching]] | |||
| | |||
*[[Pregnancy]] | |||
*[[Premature infants]] born to susceptible mothers | |||
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh =1000 grams | |||
*[[Immunocompromised]] | |||
| | |||
*[[History]] and [[physical exam]] | |||
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[Maculopapular|maculopapular lesions]]) | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
| | |||
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]] | |||
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]] | |||
*[[Prednisolone]] is [[contraindicated]] | |||
|[[File:Chickenpox18a.jpg|Chickenpox|400x400px]] | |||
|- | |||
|[[Measles]] | |||
| | |||
*[[Fever]] | |||
*[[Rash]] | |||
*[[Cough]] | |||
*[[Coryza]] (runny nose) | |||
*[[Conjunctivitis]] (pink eye) | |||
*[[Malaise]] | |||
*[[Koplick spots]] in mouth | |||
| | |||
*Unvaccinated individuals | |||
*Crowded and/or unsanitary conditions | |||
*Traveling to less developed and developing countries | |||
*Immunocompromized | |||
*Winter and [[spring]] seasons | |||
*Born after 1956 and never fully vaccinated | |||
*Health care workers | |||
| | |||
*[[History]] and [[examination]] | |||
*[[PCR]] for [[Measles]]-specific [[IgM|IgM antibody]] | |||
*[[PCR]] for [[Measles]] [[RNA]] | |||
| | |||
*[[Oral cavity]] | |||
*[[Skin]] | |||
*[[Respiratory tract]] | |||
*[[Eyes]] | |||
*[[Throat]] | |||
| | |||
*Caused by [[Morbillivirus]] | |||
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]] | |||
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[Virus|virus particles]] | |||
|[[File:Koplikspot1a.jpg|Koplick spots (Measles)|400x400px]] | |||
|}</small></small> | |||
</div> | |||
[[Category:Microbiology]] | |||
[[Category:Infectious disease]] | |||
<references /> | |||
==Causes== | ==Causes== |
Revision as of 19:08, 11 September 2017
Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
In many cases, mouth sores are attributed to herpes simplex virus and idiopathic aphthous stomatitis. Oral lesions can be indicative of a more serious underlying condition. A full review of the systems and a full skin exam are necessary to obtain an accurate diagnosis.
Differential diagnosis of oral cavity lesions
Oral Involvement =
Disease | Presentation | Risk Factors | Diagnosis | Affected Organ Systems | Important features | Picture |
---|---|---|---|---|---|---|
Diseases predominantly affecting the oral cavity | ||||||
Oral Candidiasis |
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Localized candidiasis
Invasive candidasis |
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Herpes simplex oral lesions |
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Aphthous ulcers |
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Squamous cell carcinoma |
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Leukoplakia |
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Melanoma |
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Fordyce spots |
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Burning mouth syndrome |
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Torus palatinus |
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Diseases involving oral cavity and other organ systems | ||||||
Behcet's disease |
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Crohn's disease |
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Agranulocytosis |
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Syphilis |
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Coxsackie virus |
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Chicken pox |
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Measles |
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Causes
Causes in Alphabetical Order[1][2]
- Agranulocytosis
- Aphthous stomatitis
- Allergic contact dermatitis
- Behcet's disease
- Bollus disease
- Chemotherapy drugs
- Erythema multiforme
- Herpes stomatitis
- Histoplasmosis
- Primary syphilis
- Self limited viral disease
- Squamous cell carcinoma
Diagnosis
History and Symptoms
- Past medical/medicinal history
- If the lesions occur in the same locations every time, culpit is HSV
- Consider the patients sexual history
- Evaluate open and mucosal lesions
- Lichen planus - lacy white plaques
Laboratory Findings
- Culture for HSV-1
- RPR
- CBC
- Punch biopsy
Treatment
Medical Therapy
Acute Pharmacotherapies
- Orabase and topical steroids can increase speed of healing
- Aphthous stomatitis - intralesional triamcinalone injections
- HSV (recurrent) - acyclovir
- Bollous disease - corticosteroids