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Peer Reviewed

Oral and Perioral Lesions

Photo Quiz: Can You Identify These Oral and Perioral Lesions?

Volume 46 - Issue 12 - December 2006
Figure 3
Case 1: For 8 months, a 44-year-old man has had a 2-mm superficial ulcer on his tongue. The lesion is surrounded by a thin white rim and an area of white discoloration. The patient believes that the ulcer resulted from the scratching of the rough edge of a tooth against his tongue.

What approach would you take?

Case 1: Consultation with a dentist confirmed that the lesion was caused by irritation from a roughened right upper central incisor, resulting in leukoplakia lingualis with ulceration. The offending tooth was smoothed; the ulcer and leukoplakia subsequently resolved.

Leukoplakia is a common, potentially malignant oral lesion that is more frequently seen in men than in women. There are 4 types1:

  • Simple leukoplakia may be associated with repetitive trauma, as in this patient.
  • Atypical leukoplakia features dysplasia and thickening of the epithelium; often, keratinization is present.
  • Stomatitis nicotina is associated with pipe smoking.
  • Leukoedema is characterized by wrinkling of the affected area, which may also appear waterlogged from edema.

Unless leukoplakia is associated with tertiary syphilis, chronic irritation, smoking, or alcohol( abuse, the cause is usually unknown. Treatment consists of removal of the inciting agent or, if the lesion is atypical, surgical excision of the affected area.


REFERENCE:

1. Ritchie AC, Boyd W. Boyd’s Textbook of Pathology. 9th ed. Philadelphia: Lea & Febiger; 1990:974-976. (Case and photograph courtesy of Robert P. Blereau, MD.)

Figure 3
Case 2: For several months, a 26-year-old woman has had papules and erythema around her mouth that she self-treated with her husband’s topical clobetasol(. The initially minor eruption has persisted and worsened.
What is responsible for this rash?

Case 2: The rash was diagnosed as steroid-exacerbated perioral dermatitis. Acne vulgaris, rosacea, and tinea facei were also considered in the differential. Acne was unlikely because of the absence of comedones and pustules; rosacea specifically spares the area affected in this patient; and tinea facei was ruled out by a potassium hydroxideevaluation.

The culprit corticosteroid was immediately discontinued; oral tetracycline, given for 2 months, resolved the dermatitis.

Widespread application of a topical corticosteroid to dermatitis on the face can lead to a more extensive rash; the periocular areas are especially susceptible. Caution your patients to avoid the use of high-potency corticosteroids on the face unless the preparation is specifically prescribed.

(Case and photograph courtesy of Joe Monroe, PA-C.)