Clinicopathologic Review : Erythematous Ulcerative Lesions of the Oral Cavity
be differentiated clinically from LP based on the skin lesions which are typical and different from cutaneous lesions of LP in appearance and location .
Choice D . Chronic ulcerative stomatitis ( CUS ) is an immunemediated condition that affects the mucocutaneous areas , especially the oral cavity . CUS presents as erythematous ulcerated lesions surrounded by leukoplakia which clinically resemble LP . 12 This condition is typically seen in middle-aged to older females , with the tongue being the commonest location , followed by the buccal mucosa and gingiva . 13 CUS is frequently misdiagnosed as erosive LP clinically and histopathologically . However , treatment for this condition is different . Steroids are not effective in managing these patients , but hydroxychloroquine ( an antimalarial ) does help . CUS can be differentiated from erosive LP by using direct immunofluorescence , where IgG deposition can be observed in the nuclei of keratinocytes and with indirect IF , autoantibodies to the CUS protein are identified . 14 As it is not a common practice by pathologists to make use of immunofluorescence on a suspected case of erosive LP , CUS is usually underdiagnosed .
C O N C L U S I O N
Ulcerative conditions within the oral cavity are fairly common . Ulcers associated with white striations ( Wickham striae ) narrow the list of possibilities . It is important for a dentist to be able to identify the lesions , develop a good differential diagnosis , and be able to determine whether to treat or refer to a specialist .
R E F E R E N C E S
1 . Boyd AS , Neldner KH . Lichen planus . J Am Acad Dermatol 1991 ; 25 ( 4 ): 593-619 .
2 . Neville BW . Oral and maxillofacial pathology . 3rd ed . St . Louis , Mo .: Saunders / Elsevier ; 2009 .
3 . Eisen D . The clinical manifestations and treatment of oral lichen planus . Dermatol Clin 2003 ; 21 ( 1 ): 79-89 .
4 . Silverman S , Jr ., Gorsky M , Lozada-Nur F . A prospective follow-up study of 570 patients with oral lichen planus : Persistence , remission , and malignant association . Oral Surg Oral Med Oral Pathol 1985 ; 60 ( 1 ): 30-4 .
5 . Thornhill MH , Sankar V , Xu XJ , et al . The role of histopathological characteristics in distinguishing amalgam-associated oral lichenoid reactions and oral lichen planus . J Oral Pathol Med 2006 ; 35 ( 4 ): 233-40 .
6 . Baccaglini L , Thongprasom K , Carrozzo M , Bigby M . Urban legends series : Lichen planus . Oral Dis 2013 ; 19 ( 2 ): 128-43 .
7 . Assier H , Bastuji-Garin S , Revuz J , Roujeau JC . Erythema multiforme with mucous membrane involvement and Stevens-Johnson syndrome are clinically different disorders with distinct causes . Arch Dermatol 1995 ; 131 ( 5 ): 539-43 .
8 . Huff JC . Erythema multiforme and latent herpes simplex infection . Semin Dermatol 1992 ; 11 ( 3 ): 207-10 .
9 . Weston WL , Brice SL , Jester JD , et al . Herpes simplex virus in childhood erythema multiforme . Pediatrics 1992 ; 89 ( 1 ): 32-4 .
10 . Barnes L . Surgical pathology of the head and neck . New York : Informa healthcare ; 2009 .
11 . Burge SM , Frith PA , Juniper RP , Wojnarowska F . Mucosal involvement in systemic and chronic cutaneous lupus erythematosus . Br J Dermatol 1989 ; 121 ( 6 ): 727-41 .
12 . Beutner EH , Jaremko , W . M , Kumar , V . et al . Stratified epithelium specific antinuclear antibodies ( SES-ANA ) in chronic ulcerative stomatitis ( CUS ): Is SES associated CUS a new clinical entity ? J Invest Dermatol 1989 ( 92 ): 403 .
13 . Scully C , Porter SR . The clinical spectrum of desquamative gingivitis . Semin Cutan Med Surg 1997 ; 16 ( 4 ): 308-13 .
14 . Solomon LW . Chronic ulcerative stomatitis . Oral Dis 2008 ; 14 ( 5 ): 383-9 .
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