Tugas Jurnal Blok 12

8/9/2019 Tugas Jurnal Blok 12

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Clinical and Experimental Dermatology

Oral ulcers: clinical aspects. A tool for dermatologists. Part II. Chronic

ulcers

M. Mun˜oz-Corcuera, G. Esparza-Go´mez, M. A. Gonza´lez-Moles* and A. Bascones-Martı´nez*Stomatology epartment, ental Sc!ool, Complutense "n#$ers#ty o% Madr#d, Madr#d, Spa#n& and *epartment o% 'ral Med#c#ne and

(er#odont#cs, Complutense "n#$ers#ty o% Madr#d, Madr#d, Spa#n

do#)+../0-11+.1++2.+12.3

Summary Oral ulcers are generally painful lesions that are related to various conditions developing ithin the oralcavity. !hey can "e classified as acute or chronic according to their presentation and

progression. Acute oral ulcers are "e associated ith conditions such as trauma# recurrent

aphthous stomatitis# $ehc%et&s disease# "acterial and viral infections# allergic reactions or adverse drug reactions. Chronic oral ulcers are associated ith conditions such as oral

lichen planus# pemphigus vulgaris# mucosal pemphigoid# lupus erythematosus# mycosis

and some "acterial and parasitic diseases. !he correct differential diagnosis is necessary to

esta"lish the appropriate treatment# ta'ing into account all the possi"le causes of ulcers in

the oral cavity. In this second part of this to(part revie# chronic oral ulcers are revieed.

1++2 4!e Aut!or5s6

70/ 8ournal comp#lat#on 1++2 Br#t#s! Assoc#at#on o% ermatolog#sts ) Cl#n#cal and E3per#mental ermatology, 7, 70/97/

Cl#n#cal dermatology ) :e$#e; art#cle


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4a@le Chronic oral ulcers.

#agnos#s Cl#n#cal %eatures

rug-#nduced ulcers S#ngle, #solated ulcers, located on t!e s#de o% t!e tongue, surrounded @y aneryt!ematous !alo and res#stant to usual treatments

Eros#$e l#c!en planus Areas o% atrop!y, eros#ons or pa#n%ul ulcers, generally res#stant to con$ent#onaltreatments

(emp!#gus $ulgar#s Bullae appear #n oral ca$#ty 5poster#or reg#on6, %orm#ng pa#n%ul ulcers ;#t! necrot#c%undus and eryt!ematous !alo

Mucous mem@rane pemp!#go#d Spontaneous onset o% @ullae t!at read#ly rupture, g#$#ng r#se to a !#g!ly pa#n%ul ulceratedarea

5most common areas are palate and g#ng#$a6

upus eryt!ematosus Eryt!ema and oral ulcers, ;#t!out #ndurat#on and accompan#ed @y ;!#t#s! str#ae and atendency to @leed#ng

:e#terDs syndrome Art!r#t#s, uret!r#t#s, conunct#$#t#s and oral ulcers s#m#lar to t!ose o% recurrent ap!tousstomat#t#s

4u@erculos#s (r#mary tu@erculos#s) deep, #rregular, pers#stent and pa#n%ul ulcer on t!e tongue, ;#t!rolled @order and granulat#on t#ssue #n t!e %undus

Secondary tu@erculos#s) c!ron#c ulcer, pa#n%ul and #ndurated

Mycos#s Mycoses g#$e r#se to c!ron#c ulcers on t!e oral mucosa, most commonly #n#mmunocomprom#sed pat#ents

't!er @acter#al and paras#t#cd#seases

le@s#ella and e#s!man#a spp. can produce c!ron#c oral ulcers #n F


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Oral ulcers: clinical aspects ) ?. ?unBo+(Corcuera et al.

>#gure 1 ?ucous mem"rane pemphigoid: ulcer on the soft palate.

reveals the presence of Ig or Ig? and complement

fragments in intercellular spaces.,3#,4

Mucous mem@rane pemp!#go#d

!his group of immunological diseases mainly affects

mucosae# ith su"epithelial "ullae and deposits of

immunoglo"ulin # immunoglo"ulin A or complement

fraction C throughout the "asal mem"rane. ??P

occasionally involves the s'in# oral and ocular mucosa#

oesophagus# nasopharynx and larynx. Patients ith

??P produce anti"odies that attac' several autoantigens

of the mucosal or epidermal "asal mem"rane. !he most

common autoantigens are laminin(3# type I< collagen#

laminin(4# su"unit "/ of integrin# uncein# and "ullous

pemphigoid antigens , and -.,5

??P develops in the oral mucosa ith thespontaneous onset of "ullae that readily rupture# giving

rise to a very painful ulcerated area. !he most commonly

involved areas are the palate 0>ig. -1 and gingiva#

commonly in the form of chronic des@uamative

gingivitis.,5

upus eryt!ematosus

=upus erythematosus 0=E1 is an autoimmune disease of

the connective tissue that appears in to forms: systemic

=E and discoid =E. $oth forms give rise to oral features

similar to those of lichen planus# and they may precedeor follo the cutaneous features. Discoid lesions and

facial erythema in a "utterfly& pattern appear on the

s'in# and erythematous and ulcerated areas develop on

the oral mucosa# ithout induration and ith the onset of

hitish striae and a tendency to "leeding.,6#,7

:e#terDs syndrome

eiter&s syndrome is characteri+ed "y arthritis# urethritis#

conunctivitis and oral ulcers similar to those of recurrent

aphtous stomatitis., It is an uncommon disease# and the

main diagnostic criterion is a positive reaction for human

leucocyte antigen $-5.-8

4u@erculos#s

!u"erculosis 0!$1 is a chronic granulomatous infectiousdisease# mainly caused "y ?yco"acterium tu"erculosis#

hich has regained prevalence as a severe complication of

human immunodeficiency virus 0;I


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Oral ulcers: clinical aspects ) ?. ?unBo+(Corcuera et al.

cyotoxic ! cell(mediated attac' on "asal

'eratinocytes.

) Around 38H of cases of P< "egin in the oral

mucosa# and its aetiology is related to the action

of anti"odies against specific proteins

0desmogleins1 located in desmosomes.

) ??P mainly affects mucosae. Patients produce

anti"odies that attac' several autoantigens of the

mucosal or epidermal "asal mem"rane.) Fystemic and discoid =E can give rise to oral

features similar to those of =P# and they may

precede or follo cutaneous features.

) Oral lesions in !$ are rare# resulting from

primary !$ of the oral cavity or secondary to

active pulmonary !$.

) ?ycoses of the oral cavity 0excluding

candidiases1 give rise to chronic oral ulcers

mainly in immunocompromised patients. )

Eosinophilic ulcer of the oral mucosa is

uncommon# "enign# self(limiting and generally

asymptomatic. It may resem"le a malignantlesion# "ut a "iopsy ill exclude a malignant

tumour.

) All oral cancers can produce ulcers# and the

detection of this type of ulcer is important

"ecause the tumour has a good prognosis if it is

diagnosed at an early stage.

:e%erences

, $ascones A# =lanes >. ?edicina $ucal# -nd edn. ?adrid:

Avances ?eKdico(dentales# ,774: 7/# -/,3-. -

$ascones A# >iguero E# Espar+a C. Klceras orales. ?ed

Clin 0$arc1 -883 ,-3: 3785.

Porter F# =eao LC. evie article: oral ulcers and its relevance

to systemic disorders. Aliment Pharmacol !her -883 -,: -73

84.

/Espar+a(oKme+ C# =lamas(?artKMne+ F# $ascones ?artMKne+

A. =esiones con peKrdida de sustancia: uKlceras. In: !ratado de

?edicina Interna# ,st edn 0Pere+agua(Clamagirand C# ed1.

$arcelona: Ariel# -883 /83.

3>ield EA# Allan $. evie article: oral ulceration

aetiopathogenesis# clinical diagnosis and management in the

gastrointestinal clinic. Aliment Pharmacol !her -88 ,6: 7/7 4-.

4A"dollahi ?# adfar ?. A revie of drug(induced oral reactions.

L Contemp Dent Pract -88 /: ,8,.

5Fcully C# $agan Lenoll A.

Pemphigus vulgaris. A presentation of ,/ cases and revie of

the literature. ?ed Oral Patol Oral Cir $ucal -883 ,8:

-6-6.

,4 Da Filva G# ?andel =. Early manifestation of pemphigus

vulgaris. A case report. N Q Ftate Dent L -885 5: /-/.

,5 Parisi E# aghavendra F# erth eller =# Anagnostopoulos C# $ouc'aert ?# au"enheimer EL.

;I< 9 !$ co(infection: literature revie and report of multiple

tu"erculosis oral ulcers. FADL -883 48: 8-.

-/ Fe+er $# eytinoglu ?# !uncay # nal !. Oral mucosal

ulceration: a manifestation of previously undiagnosed

pulmonary tu"erculosis. L Am Dent Assoc -88/ ,3:

4/8.

-3 ?ehra"i ?# $agheri F# =eonard ?G Lr# Perciaccante


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