DermAtlas: Online Dermatology Image Library dermatology image,morsicatio,cheek biting,tattoo, amalgam,tattoo, amalgam,Crohn disease,perleche,granulomatous reaction,cheilitis

© 2001-2010, DermAtlas	*Image Name:*	morsicatio_2_090503	*File Type:*	jpg
	*Diagnosis:*	MORSICATIO / CHEEK BITING	*Category:*	dental/oral disorder
	*Body Site:*	buccal mucosa / mouth	*Age:*	30 years
	*Contributor:*	James Scuibba
	*Description:*	thickened shredded areas of hyperkeratosis
	*Comments:*	This young adult was a chronic cheek chewer. These changes are found most commonly on the buccal mucosa, but the labial mucosa and lateral border of the tongue may also be involved. Zones of white thickening of the mocosa may be found with intervening erosions and ulceration.
	*Related Images:*	morsicatio_1_090503

© 2001-2010, DermAtlas	*Image Name:*	amalgam_tattoo_1_090401	*File Type:*	jpg
	*Diagnosis:*	TATTOO, AMALGAM / TATTOO	*Category:*	deposition disorders / dental/oral disorder / hyperpigmentation
	*Body Site:*	mouth, floor of	*Age:*	59 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	The mucosa appears normal. In the submucosa, there is an ill-defined hyperpigmented area.
	*Comments:*	This 59 year old woman had a pigmented lesion biopsied from the floor of her mouth to rule out melanoma. This is a common scenario for amalgam tattoos. These lesions develop when metals from dental work leach into the soft tissues. Common metals implicated are silver, mercury, aluminum, etc. On histology, the pigment may be black, brown, or golden. The main differential diagnosis is a melanocytic lesion, like a blue nevus, but the tattoo pigment is acellular and often accentuated on elastic fibers.
	*Related Images:*	amalgam_tattoo_2_090401

© 2001-2010, DermAtlas	*Image Name:*	amalgam_tattoo_2_090401	*File Type:*	jpg
	*Diagnosis:*	TATTOO, AMALGAM / TATTOO	*Category:*	deposition disorders / dental/oral disorder / hyperpigmentation
	*Body Site:*	mouth, floor of	*Age:*	59 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	The pigment is golden brown, with variably-sized fibers. The pigment appears extracellular and is accentuated in an elastin pattern. Black granular pigment was found more superficially (not shown). There is no significant inflammatory response.
	*Comments:*	This 59 year old woman had a pigmented lesion biopsied from the floor of her mouth to rule out melanoma. This is a common scenario for amalgam tattoos. These lesions develop when metals from dental work leach into the soft tissues. Common metals implicated are silver, mercury, aluminum, etc. On histology, the pigment may be black, brown, or golden. The main differential diagnosis is a melanocytic lesion, like a blue nevus, but the tattoo pigment is acellular and often accentuated on elastic fibers.
	*Related Images:*	amalgam_tattoo_1_090401

© 2001-2010, DermAtlas	*Image Name:*	Inflammatory_bowel_disease_11_090421	*File Type:*	jpg
	*Diagnosis:*	CROHN DISEASE / PERLECHE / GRANULOMATOUS REACTION / CHEILITIS	*Category:*	granulomatous disorder / cutaneous sign of systemic disease / dental/oral disorder / gastrointestinal disorder
	*Body Site:*	buccal mucosa / mouth	*Age:*	13 years
	*Contributor:*	James Scuibba
	*Description:*	A biopsy of the buccal mucosa revealed focal and diffuse chronic inflammation with scattered non-caseating epitheloid granulomas. Special stains were negative for acid fast bacteria, fungus, and polarizing microscopy was negative for foreign material.
	*Comments:*	These changes are consistent with but not specific of Crohn disease.
	*Related Images:*	All related Images Inflammatory_bowel_disease_1_090421 Inflammatory_bowel_disease_2_090421 Inflammatory_bowel_disease_3_090421 Inflammatory_bowel_disease_4_090421 Inflammatory_bowel_disease_5_090421 Inflammatory_bowel_disease_6_090421 Inflammatory_bowel_disease_7_090421 Inflammatory_bowel_disease_8_090421 Inflammatory_bowel_disease_9_090421 Inflammatory_bowel_disease_10_090421

© 2001-2010, DermAtlas	*Image Name:*	Inflammatory_bowel_disease_10_090421	*File Type:*	jpg
	*Diagnosis:*	CROHN DISEASE / PERLECHE / GRANULOMATOUS REACTION / CHEILITIS	*Category:*	granulomatous disorder / cutaneous sign of systemic disease / dental/oral disorder / gastrointestinal disorder
	*Body Site:*	buccal mucosa / mouth	*Age:*	13 years
	*Contributor:*	James Scuibba
	*Description:*	A biopsy of the buccal mucosa revealed focal and diffuse chronic inflammation with scattered non-caseating epitheloid granulomas. Special stains were negative for acid fast bacteria, fungus, and polarizing microscopy was negative for foreign material.
	*Comments:*	These changes are consistent with but not specific of Crohn disease.
	*Related Images:*	All related Images Inflammatory_bowel_disease_1_090421 Inflammatory_bowel_disease_2_090421 Inflammatory_bowel_disease_3_090421 Inflammatory_bowel_disease_4_090421 Inflammatory_bowel_disease_5_090421 Inflammatory_bowel_disease_6_090421 Inflammatory_bowel_disease_7_090421 Inflammatory_bowel_disease_8_090421 Inflammatory_bowel_disease_9_090421 Inflammatory_bowel_disease_11_090421

© 2001-2010, DermAtlas	*Image Name:*	Inflammatory_bowel_disease_9_090421	*File Type:*	jpg
	*Diagnosis:*	CROHN DISEASE / PERLECHE / GRANULOMATOUS REACTION / CHEILITIS	*Category:*	granulomatous disorder / cutaneous sign of systemic disease / dental/oral disorder / gastrointestinal disorder
	*Body Site:*	buccal mucosa / mouth	*Age:*	13 years
	*Contributor:*	James Scuibba
	*Description:*	A biopsy of the buccal mucosa revealed focal and diffuse chronic inflammation with scattered non-caseating epitheloid granulomas. Special stains were negative for acid fast bacteria, fungus, and polarizing microscopy was negative for foreign material.
	*Comments:*	These changes are consistent with but not specific of Crohn disease.
	*Related Images:*	All related Images Inflammatory_bowel_disease_1_090421 Inflammatory_bowel_disease_2_090421 Inflammatory_bowel_disease_3_090421 Inflammatory_bowel_disease_4_090421 Inflammatory_bowel_disease_5_090421 Inflammatory_bowel_disease_6_090421 Inflammatory_bowel_disease_7_090421 Inflammatory_bowel_disease_8_090421 Inflammatory_bowel_disease_10_090421 Inflammatory_bowel_disease_11_090421

© 2001-2010, DermAtlas	*Image Name:*	Inflammatory_bowel_disease_8_090421	*File Type:*	jpg
	*Diagnosis:*	CROHN DISEASE / PERLECHE / GRANULOMATOUS REACTION / CHEILITIS	*Category:*	granulomatous disorder / cutaneous sign of systemic disease / dental/oral disorder / gastrointestinal disorder
	*Body Site:*	buccal mucosa / mouth	*Age:*	13 years
	*Contributor:*	James Scuibba
	*Description:*	A biopsy of the buccal mucosa revealed focal and diffuse chronic inflammation with scattered non-caseating epitheloid granulomas. Special stains were negative for acid fast bacteria, fungus, and polarizing microscopy was negative for foreign material.
	*Comments:*	These changes are consistent with but not specific of Crohn disease.
	*Related Images:*	All related Images Inflammatory_bowel_disease_1_090421 Inflammatory_bowel_disease_2_090421 Inflammatory_bowel_disease_3_090421 Inflammatory_bowel_disease_4_090421 Inflammatory_bowel_disease_5_090421 Inflammatory_bowel_disease_6_090421 Inflammatory_bowel_disease_7_090421 Inflammatory_bowel_disease_9_090421 Inflammatory_bowel_disease_10_090421 Inflammatory_bowel_disease_11_090421

© 2001-2010, DermAtlas	*Image Name:*	Inflammatory_bowel_disease_7_090421	*File Type:*	jpg
	*Diagnosis:*	CROHN DISEASE / PERLECHE / GRANULOMATOUS REACTION / CHEILITIS	*Category:*	granulomatous disorder / cutaneous sign of systemic disease / dental/oral disorder / gastrointestinal disorder
	*Body Site:*	buccal mucosa / mouth	*Age:*	13 years
	*Contributor:*	James Scuibba
	*Description:*	A biopsy of the buccal mucosa revealed focal and diffuse chronic inflammation with scattered non-caseating epitheloid granulomas. Special stains were negative for acid fast bacteria, fungus, and polarizing microscopy was negative for foreign material.
	*Comments:*	These changes are consistent with but not specific of Crohn disease.
	*Related Images:*	All related Images Inflammatory_bowel_disease_1_090421 Inflammatory_bowel_disease_2_090421 Inflammatory_bowel_disease_3_090421 Inflammatory_bowel_disease_4_090421 Inflammatory_bowel_disease_5_090421 Inflammatory_bowel_disease_6_090421 Inflammatory_bowel_disease_8_090421 Inflammatory_bowel_disease_9_090421 Inflammatory_bowel_disease_10_090421 Inflammatory_bowel_disease_11_090421

© 2001-2010, DermAtlas	*Image Name:*	Inflammatory_bowel_disease_6_090421	*File Type:*	jpg
	*Diagnosis:*	CROHN DISEASE / PERLECHE / GRANULOMATOUS REACTION / CHEILITIS	*Category:*	granulomatous disorder / cutaneous sign of systemic disease / dental/oral disorder / gastrointestinal disorder
	*Body Site:*	buccal mucosa / mouth	*Age:*	13 years
	*Contributor:*	James Scuibba
	*Description:*	A biopsy of the buccal mucosa revealed focal and diffuse chronic inflammation with scattered non-caseating epitheloid granulomas. Special stains were negative for acid fast bacteria, fungus, and polarizing microscopy was negative for foreign material.
	*Comments:*	These changes are consistent with but not specific of Crohn disease.
	*Related Images:*	All related Images Inflammatory_bowel_disease_1_090421 Inflammatory_bowel_disease_2_090421 Inflammatory_bowel_disease_3_090421 Inflammatory_bowel_disease_4_090421 Inflammatory_bowel_disease_5_090421 Inflammatory_bowel_disease_7_090421 Inflammatory_bowel_disease_8_090421 Inflammatory_bowel_disease_9_090421 Inflammatory_bowel_disease_10_090421 Inflammatory_bowel_disease_11_090421

© 2001-2010, DermAtlas	*Image Name:*	Inflammatory_bowel_disease_5_090421	*File Type:*	jpg
	*Diagnosis:*	CROHN DISEASE / PERLECHE / GRANULOMATOUS REACTION / CHEILITIS	*Category:*	granulomatous disorder / cutaneous sign of systemic disease / dental/oral disorder / gastrointestinal disorder
	*Body Site:*	buccal mucosa / mouth	*Age:*	13 years
	*Contributor:*	James Scuibba
	*Description:*	cobblestoning of the mucosa with linear ulcers and hyperplastic folds
	*Comments:*	This 13-year-old girl was referred for evaluation of oral ulcerations, facial swelling and oral pain. A concomitant history of swelling involving the lower lip, cheeks and cervical lymphadenopathy was also noted. Last year she missed 27 school days due to abdominal pain. She had a tonsillectomy at 2 years of age and complained of severe depression and anxiety, nasal stuffiness, asthma, and abdominal pain. She had multiple treatments including oral antibiotics, parenteral antibiotics, chlorhexidine rinses, and topical steroids. A biopsy of the buccal mucosa revealed focal and diffuse chronic inflammation with scattered non-caseating epitheloid granulomas. Special stains were negative for acid fast bacteria, fungus, and polarizing microscopy was negative for foreign material. Further evaluation by pediatric gastroenterology including upper and lower gastrointestinal tract studies showed characteristic changes of Crohn disease. Oral and gastrointestinal lesions and symptoms resolved with treatment of her inflammatory bowel disease.
	*Related Images:*	All related Images Inflammatory_bowel_disease_1_090421 Inflammatory_bowel_disease_2_090421 Inflammatory_bowel_disease_3_090421 Inflammatory_bowel_disease_4_090421 Inflammatory_bowel_disease_6_090421 Inflammatory_bowel_disease_7_090421 Inflammatory_bowel_disease_8_090421 Inflammatory_bowel_disease_9_090421 Inflammatory_bowel_disease_10_090421 Inflammatory_bowel_disease_11_090421