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 © 2001-2009, DermAtlas | Image Name: | Heat_Induced_Vitiligo_1_090617 | File Type: | jpg | |
| Diagnosis: | VITILIGO | Category: | hypopigmentation, depigmentation | ||
| Body Site: | mouth / gingiva | Age: | 26 years | ||
| Contributor: | Sugathan Paramoo, MD, FRCP(Glasg) | ||||
| Description: | symmetric depigmentation | ||||
| Comments: | This 26-year-old man complained of depigmentation of the lip margins for 7 years. The upper and lower gingivae were also noted to be involved on examination. He confessed to taking his coffee and tea very hot! Betnesol gargles and takinng his tea and coffee lukewarm slowly reversed the condition. | ||||
 © 2001-2009, DermAtlas | Image Name: | cyclosporine_induced_gingival_enlargment_1_090518 | File Type: | jpg | |
| Diagnosis: | CYCLOSPORINE INDUCED GINGIVAL HYPERPLASIA / GINGIVAL HYPERPLASIA / DRUG REACTION / GINGIVAL HYPERPLASIA, CYCLOSPORINE INDUCED | Category: | dental/oral disorder / drug reaction / treatment complication | ||
| Body Site: | gingiva | Age: | 33 years | ||
| Contributor: | Roshna Thattankandy, MD | ||||
| Description: | thickening of the gingiva with some crusting and hemorrhage | ||||
| Comments: | This 33-year-old man complained of progressive thickening of his gums associated with bleeding and difficulty chewing food for 6 months. Two years earlier he was diagnosed with aplastic anemia and started on cyclosporine which has been associated with gingival hyperplasia. | ||||
 © 2001-2009, DermAtlas | Image Name: | Cicatricial_Pemphigoid_1_050404 | File Type: | jpg | |
| Diagnosis: | CICATRICIAL PEMPHIGOID / ULCER | Category: | dental/oral disorder / vesiculobullous eruptions / vesiculobullous eruptions, immunobullous | ||
| Body Site: | mouth / gingiva | Age: | 73 years | ||
| Contributor: | Vilma Pineda, DDS | ||||
| Description: | scattered erosions | ||||
| Comments: | This 73-year-old woman, who was initially diagnosed with desquamative gingivitis and failed to improve on antibiotics, had an erosive scarring gingivitis and stomatitis which showed the characteristic histologic and immunfluorescent findings for cicatricial pemphigoid. | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_1_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | mouth / gingiva | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | superficial erosions and friable pink and white gingiva | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_7_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | mouth / gingiva | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | Hydropic degeneration of the basal cell layer is evident with numerous apoptotic pink keratinocytes (Civatte bodies). An intense lymphocytic infiltrate is present in the superficial lamina propria. These changes are typical of lichen planus of the oral mucosa. | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_5_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | mouth / gingiva | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | There is a full thickness ulceration adjacent to intact epithelium with an intense lymphocytic and plasma cell infiltrate in the superficial lamina propria. | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_6_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | mouth / gingiva | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | Hydropic degeneration of the basal cell layer is evident with numerous apoptotic pink keratinocytes (Civatte bodies). An intense lymphocytic infiltrate is present in the superficial lamina propria. These changes are typical of lichen planus of the oral mucosa. | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | pyorrhea_alveolaris_1_041024 | File Type: | jpg | |
| Diagnosis: | PERIODONTITIS / PYORRHEA ALVEOLARIS | Category: | dental/oral disorder | ||
| Body Site: | mouth / gingiva tooth | Age: | 40 years | ||
| Contributor: | Kosman Sadek Zikry, MD | ||||
| Description: | erythema, edema, crusting and purulent discharge from the gingival tissue | ||||
| Comments: | This 40-year-old man with poor oral hygiene developed chronic periodontitis. | ||||
 © 2001-2009, DermAtlas | Image Name: | Thrush_1_041024 | File Type: | jpg | |
| Diagnosis: | THRUSH / CANDIDIASIS | Category: | infections and infestations / dental/oral disorder / neonatal dermatology | ||
| Body Site: | mouth / tongue lip / gingiva | Age: | 12 days | ||
| Contributor: | Douglas Hoffman, MD | ||||
| Description: | thick coat of confluent white reticulated patches | ||||
| Comments: | This healthy 12-day-old infant developed thrush with involvement of the tongue, gingivae, buccal mucosa, palate, and lips. This is a common finding and typically does not require investigation in healthy infants under 12 months of age. Rapid clearance was achieved by applying nystatin suspension to the oral mucosa four times a day. Other measures included application of nystatin to mother's nipples and boiling latex nipples after each use. | ||||
 © 2001-2009, DermAtlas | Image Name: | congenital_epulis_10_030601 | File Type: | jpg | |
| Diagnosis: | EPULIS, CONGENITAL / GRANULAR CELL TUMOR | Category: | neonatal dermatology / dental/oral disorder | ||
| Body Site: | mouth / gingiva maxilla | Age: | 3 days | ||
| Contributor: | Bernard Cohen, MD | ||||
| Description: | pedunculated mushroon shaped rubbery mass arising from the maxillary alveolar ridge | ||||
| Comments: | This healthy newborn had a pedunculated nodule arising from the maxillary ridge at birth. Histologic features were characteristic of a congenital gingival granular cell tumor. The lesion was excised uneventfully in the newborn period. | ||||
| Related Images: | congenital_epulis_11_030601 | ||||
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