RED LESIONS of Oral Cavity: RED LESIONS of Oral Cavity BY : Dr . Siddharth Konwar What are RED LESIONS ?: What are RED LESIONS ? Red lesions are a large, heterogeneous group of disorders of the oral mucosa. TYPES OF RED LESIONS: TYPES OF RED LESIONS Traumatic erythema Thermal burn Radiation mucositis Pyogenic granuloma Geographic tongue Median rhomboid glossitis Denture stomatitis Erythematous candidiasis Squamous-cell carcinoma Erythroplakia Plasma-cell gingivitis Granulomatous gingivitis Desquamative gingivitis PowerPoint Presentation: Linear gingival erythema Gonococcal stomatitis Hemangioma Lupus erythematosus CREST syndrome Hereditary hemorrhagic telangiectasia Anemia Thrombocytopenic purpura Infectious mononucleosis Reiter syndrome Peripheral ameloblastoma Sturge–Weber angiomatosis Contact allergic stomatitis TRAUMATIC ERYTHEMA: TRAUMATIC ERYTHEMA Definition and etiology : Traumatic erythema occurs when a traumatic effect results in hemorrhage within the oral tissues. Clinical features :Traumatic erythema can present either as an ecchymosis or as a hematoma. Differential diagnosis : Hematomas due to anticoagulants, thrombocytopenia, thrombasthenia. Treatment : Symptomatic treatment. THERMAL BURN: THERMAL BURN Definition and etiology : Thermal burns to the oral mucosa are fairly common, usually due to contact with very hot foods, liquids, or hot metal objects. Clinical features : Clinically, the condition appears as a red, painful erythema that may undergo desquamation, leaving erosions. Differential diagnosis :Chemical burn, traumatic lesions, herpes simplex, aphthous ulcers, drug reactions. Treatment :Systemic analgesics,topical hydrocarbon and antibiotics for secondary infection. RADIATION MUCOSITIS: RADIATION MUCOSITIS Definition and etiology :Oral radiation mucositis is a side effect of radiation treatment of head and neck tumors. Clinical features :Early reactions may begin at the end of the first week of radiotherapy, and consist of erythema and edema of the oral mucosa. Differential diagnosis :Mucositis due to chemotherapy, graft-versushost disease, erythema multiforme, herpetic stomatitis, lichen planus. Treatment :Supportive and Cessation of the radiation treatment, B-complex vitamins, and sometimes low doses of steroids are indicated. PYOGENIC GRANULOMA: PYOGENIC GRANULOMA Definition and etiology : It is a tumour like growth that is considered as a response to minor trauma. Clinical features :It occurs at an early age mostly in the gingiva and commonly seen in females small,pedunculated or sessile painless growth and bleeds on provocation. Differential diagnosis :Exophytic capillary hemangioma ,peripheral giant cell granuloma. Treatment :Surgical excision or removal of irritant. GEOGRAPHIC TONGUE: GEOGRAPHIC TONGUE Definition :Geographic tongue is psoriasiform mucositis of the dorsum of the tongue. Clinical features:It presents as multiple, well-demarcated patches of erythema surrounded by a thin, raised, whitish border. Differential diagnosis :Psoriasis, Reiter syndrome, plasma-cell stomatitis, mucous patches of secondary syphilis, candidiasis. Treatment :Topical tetracycline and prednisolone. MEDIAN RHOMBOID GLOSSITIS: MEDIAN RHOMBOID GLOSSITIS Definition :Median rhomboid glossitis is a rare condition that occurs exclusively on the dorsumof the tongue. Clinical features : It presents as a well-demarcated erythematous rhomboid area along the midline of the dorsum of the tongue, immediately anterior to the circumvallate papillae. Differential diagnosis : Candidiasis, lymphangioma, geographic tongue, syphilis, hemangioma. Treatment :Antifungal regimen, including replacement of the toothbrush, and any other oral device that may cause reinfection by the organism. DENTURE STOMATITIS: DENTURE STOMATITIS Definition :Denture stomatitis, or denture sore mouth, is a frequent condition in patients who wear dentures continuously for extended times. Clinical features :The condition is characterized by diffuse erythema, edema, and sometimes petechiae and white spots that represent accumulations of candidal hyphae, almost always located in the denturebearing area of the maxilla. Differential diagnosis :Allergic contact stomatitis due to acrylic. Treatment : Improvement of denture fit, oral hygiene, and topical antimycotics. ERYTHEMATOUS CANDIDIASIS: ERYTHEMATOUS CANDIDIASIS Definition : Erythematous candidiasis is a relatively common form of candidiasis, with a high incidence in HIV-infected patients and rarely in patients receiving broad-spectrumantibiotics or steroids. Clinical features : It is characterized by erythematous patches or large areas, usually located on the dorsumof the tongue and palate. Treatment :Topical clotrimazole & Topical itraconazole. SQUAMOUS CELL CARCINOMA: SQUAMOUS CELL CARCINOMA Definition and etiology : Squamous cell carcinoma is a histologically distinct form of cancer and it arises from the uncontrolled multiplication of malignant cells deriving from epithelium Clinical features : Usually the tumor presents as an ulcerated lesion with hard, raised edges. On the lip, the tumor forms a small ulcer, which fails to heal and bleeds intermittently Differential diagnosis : Basal cell carcinoma. Treatment : Surgical excision with free margin of healthy tissue,radiotherapy, electrodesiccation and curettage . ERYTROPLAKIA: ERYTROPLAKIA Definition : Erythroplakia is defined as a red, nonspecific patch or plaque that cannot be classified clinically and pathologically under any other disease. Clinical features : It appears as a usually asymptomatic, fiery red, well demarcated plaque, with a smooth and velvety surface. Differential diagnosis : Erythematous candidiasis, lichen planus, discoid lupus erythematous. Treatment : Removal of cause, surgical stripping. PLASMA CELL GINGIVITIS: PLASMA CELL GINGIVITIS Definition : Plasma-cell gingivitis is a rare and unique gingival disorder, characterized histopathologically by a dense chronic inflammatory infiltration of the lamina propria, mainly of plasma cells. Clinical features : Clinically, both freeand attached gingiva are bright red and edematous, with a loss of normal stippling. Differential diagnosis : Desquamative gingivitis, psoriasis, candidiasis, soft-tissue plasmacytoma, erythroplakia. Treatment : Removal of the allergens if possible. Topical or systemic steroids. GRANULOMATOUS GINGIVITIS: GRANULOMATOUS GINGIVITIS Definition and etiology : Granulomatous gingivitis is a relatively rare, chronic inflammatory disorder with a specific histopathological pattern caused by foreign body reaction, local bacterial or fungal infection, reactions to food additives and systemic granulomatous disorder. Clinical features : It as a diffuse erythematous and slightly edematous area of the free and attached gingiva, and of the interdental papillae. Differential diagnosis :Plaque-related chronic gingivitis, desquamative gingivitis, linear gingiva erythema, trauma, plasma-cell gingivitis, drug reactions, candidiasis, erythroplakia. Treatment : Local or systemic corticosteroids. DESQUAMATIVE GINGIVITIS: DESQUAMATIVE GINGIVITIS Definition : Desquamative gingivitis is a clinical descriptive term used for nonspecific gingival manifestation of several chronic mucocutaneous diseases. Clinical features :It presents as erythema and edema of the marginal and attached gingiva. Differential diagnosis :Necrotizing ulcerative gingivitis, plasma cell gingivitis, plaque related gingivitis, drug reactions. Treatment :Good oral hygiene. LINEAR GINGIVAL ERYTHEMA: LINEAR GINGIVAL ERYTHEMA Definition : Linear gingival erythema is a relatively uncommon gingival disorder usually following HIV infection. Clinical features :It appears as a fiery red band (2–4 mmwide) along the margin of the gingiva and a punctate or diffuse erythema of the attached gingival. Differential diagnosis : Plaque-related gingivitis, herpetic gingivitis desquamative gingivitis, granulomatous gingivitis. Treatment : High level of oral hygiene and plaque control. GONOCOCCAL STOMATITIS: GONOCOCCAL STOMATITIS Definition :Gonococcal stomatitis is a rare manifestation of gonococcal infection and is a sexually transmitted disease. Clinical features :The oral manifestations of gonococcal infection appear as atypical fiery erythema and edema with or without superficial ulceration covered with a grayish or yellowish-exudate. Differential diagnosis : Streptococcal stomatitis, herpetic stomatitis, erythematous candidiasis. Treatment :Systemic penicillin or tetracycline are the drugs of choice. HEMANGIOMA: HEMANGIOMA Definition and etiology : Hemangioma is a relatively common benign proliferation of blood vessels that primarily develops during childhood and is developmental. Clinical features :Two main forms of hemangioma are recognized:capillary and cavernous. The capillary formpresents as a flat red area consisting of numerous small capillaries. Cavernous hemangioma appears as an elevated lesion of a deep red color. Differential diagnosis :Pyogenic granuloma, lymphangioma. Treatment : Sclerosing agent such as Sodium tetradecyl sulfate and cryosurgery. LUPUS ERYTHEMATOSUS: LUPUS ERYTHEMATOSUS Definition : Lupus erythematosus is a chronic immunologically mediated disease. Clinical features : The oral lesions are characterized by a well-defined central atrophic red area surrounded by a sharp elevated border of irradiating whitish striae. Differential diagnosis :Lichen planus, geographic glossitis, speckled leukoplakia, erythroplakia. Treatment :Steroids. CREST SYNDROME: CREST SYNDROME Definition : CREST syndrome is a clinical variant of scleroderma characterized by a combination of Calcinosis cutis, Reynaud phenomenon, Esophageal dysfunction. Clinical features : Telangiectasia(small dilated blood vessels near the surface of the skin ) in the lips. Treatment : Surgical excision, or cryotherapy or laser therapy. HEREDITARY HEMORRHAGIC TELANGIECTASIA: HEREDITARY HEMORRHAGIC TELANGIECTASIA Definition :Hereditary hemorrhagic telangiectasia is a rare mucocutaneous disorder characterized by dysplasia of the capillaries and small vessels. Clinical features : The oral mucosa is frequently involved and the lesions present as multiple bright red papules, 1–2 mm in size, which disappear on pressure from a glass slide. Differential diagnosis : CREST syndrome. Treatment :Supportive treatment. ANEMIA: ANEMIA Definition : It is an abnormal reduction in the number of circulating red blood cells,the quantity of hemoglobin and the volume of packed red cells in a given unit of blood. Clinical features : Pallor and atrophy of mucosa,a ngular chelitis,ulcer formation,slow healing,gingival enlargement,smooth red tongue,burning sensation ,loss of taste. Treatment : Iron supplements( ferrous fumerate or ferrous sulphate ). THROMBOCYTOPENIC PURPURA: THROMBOCYTOPENIC PURPURA Definition :It is a hematological disorder characterized by a decrease in platelets in the peripheral blood. Clinical features : The oral manifestations consist of red lesions in the form of petechiae, ecchymoses, or even hematomas, usually located on the palate and buccal mucosa. Differential diagnosis : Aplastic anemia, leukemias. Treatment :Steroids, platelet transfusions, cessation of drug treatment if it is drug-related. INFECTIOUS MONONUCLEOSIS: INFECTIOUS MONONUCLEOSIS Definition and etiology : Infectious mononucleosis is an acute, self-limited infectious disease that primarily affects children caused by Epstein–Barr virus transmitted through saliva transfer. Clinical features : The oral manifestations are early and common, and consist of palatal petechiae, uvular edema, tonsillar exudate, gingivitis, and rarely ulcers. Differential diagnosis : Leukemias, secondary syphilis, diphtheria. Treatment : Symptomatic treatment. REITER’S SYNDROME: REITER’S SYNDROME Definition : Reiter disease is an uncommon multisystemic disorder that predominantly affects young men aged 20–30 years. Clinical features : The main clinical manifestations are nongonococcal urethritis, cyclic balanitis, symmetrical arthritis of six to seven joints, conjunctivitis, buccal mucosa, gingiva, palate, lips, and tongue are more frequently affected. Treatment : Systemic corticosteroids and nonsteroidal anti-inflammatory agents are the drugs of choice. PERIPHERAL AMELOBLASTOMA: PERIPHERAL AMELOBLASTOMA Definition : It is a tumor which histologically resembles the typical central or intraosseous ameloblastoma but which occurs in the soft tissue outside and overlying the alveolar bone. Clinical features :Peripheral ameloblastoma is rare and accounts for about 1–2% of all ameloblastomas. It usually presents as a painless, slowgrowing, nonulcerated, sessile red mass. The size of the lesion varies between 1 and 2 cm. Treatment : Local surgical excision. STURGE - WEBER ANGIOMATOSIS: STURGE - WEBER ANGIOMATOSIS Definition : It is a relatively rare, sporadic congenital capillary vascular malformation typically involving areas innervated by the trigeminal nerve. Clinical features : Oral manifestations have a bright red or purple color and are usually flat but may also be raised, causing tissue enlargement. Differential diagnosis : Solitary hemangioma. Treatment : Laser therapy is recommended. CONTACT ALLERGIC STOMATITIS: CONTACT ALLERGIC STOMATITIS Definition : It is a hypersensitivity mechanism of the cellular or delayed type and is, like contact dermatitis on the skin, the result of a sensitization to a substance with which one has previously come in contact, the "contact allergen". Clinical features : Burning sensation,pain,paresthesia,numbness,bad taste,excessive salivation. Treatment : Removal of the causative agent , intraoral topical steroids are prescribed in severe cases . : Thank You !