Differential Diagnoses of Red Lesions

8/15/2019 Differential Diagnoses of Red Lesions

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DifferentialDiagnoses of Oral

Red Lesions・ Farizal ・ Sara Yasmin ・ Asma Mahirah ・

Farhana Fikri ・


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Introduction

Red color of the lesions may be due tothin epithelium inflammation dilatationof blood !essels or increased numbers ofblood !essels and e"tra!asation of bloodinto the oral soft tissues#


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Oral Red Lesions $raumatic erythema

$hermal burn

Radiation mucositis

Fellatio

%eographic tongue

Median rhomboid glossitis

Denture stomatitis

&rythematous candidiasis

S'uamous(cell carcinoma

&rythroplakia

)lasma(cell gingi!itis

%ranulomatous gingi!itis

Des'uamati!e gingi!itis

Linear gingi!al erythema

*ontact allergic stomatitis

%onococcal stomatitis

+emangioma

Lupus erythematosus

*R&S$ syndrome

+ereditary hemorrhagictelangiectasia

Anemia

$hrombocytopenic purpura

,nfectious mononucleosis Reiter disease

)eripheral ameloblastoma

Sturge-.eber angiomatosis


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Traumatic ErythemaDefinition /Aetiology

$raumatic erythema occurs 0hen atraumatic effect results inhemorrhage 0ithin the oral tissues#

*linical Features $raumatic erythema can present eitheras an ecchymosis or as a hematoma#

*linically it appears as anirregular usually flat area 0ith abright or deep red color# $he lipstongue and buccal mucosa are themost common areas affected# $hediagnosis is based on the history and

the clinical features#

$reatment 1o treatment is re'uired#


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$raumatic +aematoma on lo0er lip


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Thermal BurnDefinition /Aetiology

$hermal burns to the oral mucosa arefairly common usually due to contact0ith !ery hot foods li'uids or hotmetal ob2ects#

*linical Features *linically the condition appears as

a red painful erythema that mayundergo des'uamation lea!ingerosions# $he lesions healspontaneously in about a 0eek# $hediagnosis is made e"clusi!ely onclinical grounds



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&rosions on the dorsum of the tonguecaused by !ery hot food


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Radiation MucositisDefinition /Aetiology

Oral radiation mucositis is a sideeffect of radiation treatment of headand neck tumors#

*linical Features $he oral lesions are classified asearly and late# &arly reactions may

begin at the end of the first 0eek ofradiotherapy and consist of erythemaand edema of the oral mucosa# Soonaftererosions or ulcers may de!elopco!ered by a 0hitish(yello0 e"udate#3erostomia loss of taste and

burning and pain during mastications0allo0ing and speech are common#$he diagnosis is made clinically#

$reatment Supporti!e# *essation of theradiation treatment 4(comple"

!itamins and sometimes lo0 doses ofsteroids are indicated#


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FellatioDefinition Fellatio is se"ually produced lesion

that e"clusi!ely appears in the mouth

Aetiology Orogenital se" and the negati!epressure or repeated 5irritation6applied during fellatio#

*linical Features $he lesions present as petechiaeerythema or ecchymoses usually at the2unction of the soft and hard palate#$hey disappear spontaneously 0ithin a0eek and the diagnosis is made on thebasis of the history and the clinical

features#

D7D" $hermal burn trauma erythematouscandidiasis infectious mononucleosisthrombocytopenic purpura leukemia

$reatment 1o treatment is re'uired


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&rythema on the palate caused after fellatio


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Geographic Tongue

*linicalFeatures

)resents as multiple 0ell(demarcatedpatches of erythema surrounded by a thinraised 0hitish border# *haracteristicallythe lesions persist for a short time in onearea disappear 0ithin a fe0 days and then

de!elop in another area# $he dorsal surfaceof the tongue is the site of predilectionbut infre'uently the lesions may appear atother mucosal sites# $he diagnosis is madeon the basis of clinical criteria

D7D" )soriasis Reiter syndrome plasma(cellstomatitis mucous patches of secondarysyphilis candidiasis#



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%eographic tongue8 0ell(demarcated redpatch on the tongue


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Median RhomboidGlossitis

Definition Median rhomboid glossitis is a rarecondition that occurs e"clusi!ely on thedorsumof the tongue#

Aetiology )resumably de!elopmental# Candida

albicans may also be in!ol!ed#*linical Features ,t presents as a 0ell(demarcated

erythematous rhomboid area along themidline of the dorsum of the tongueimmediately anterior to thecircum!allate papillae# $he surface of

the lesion may be smooth or lobulated#

D7D" *andidiasis lymphangioma geographictongue syphilis hemangioma non(+odgkin lymphoma#



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Median rhomboid glossitis


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enture !tomatitisDefinition Denture stomatitis or denture sore

mouth is a fre'uent condition inpatients 0ho 0ear dentures continuouslyfor e"tended times#

Aetiology Mechanical irritation fromdentures

Candida albicans or a tissue responseto microorganisms li!ing beneath thedentures#

*linical Features $he condition is characterized bydiffuse erythema edema and sometimespetechiae and 0hite spots that

represent accumulations of candidalhyphae almost al0ays located in thedenturebearing area of the ma"illa# $hecondition is usually asymptomatic# $hediagnosis is based on clinicalcriteria#

D7D" Allergic contact stomatitis due to


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Denture stomatitis


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&rythematous candidiasis is a relati!ely commonform of candidiasis 0ith a high incidence in +,9(infected patients and rarely in patients recei!ingbroad(spectrumantibiotics or steroids# ,t may beacute or chronic#*linically it is characterized by erythematous

patches or large areas usually located on thedorsumof the tongue and palate# A burning sensationis a common symptom#

+,9 infection8 erythematous candidiasis on the dorsum of

"andidiasis

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$he early stage of s'uamous(cell carcinoma

may present as an asymptomatic atypical redpatch#$he clinical features are identical toerythroplakia erythematous candidiasis orcontact reactions to dental materials# ,nthese cases a biopsy should be taken to

allo0 a conclusi!e diagnosis#

&arly s'uamous cell carcinoma presenting as a red patch on

#uamous$ e"arcinoma


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S'uamous cellcarcinoma presentingas a red mass on thelateral border of thetongue#

S'uamous(cellcarcinoma presentingas a red patch onthe palate

E h l &i


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e%inition &rythroplakia or :ueyrat erythroplasia is apremalignant lesion fre'uently occurring on the glans penisand rarely on the oral mucosa# ,t is defined as a red

nonspecific patch or pla'ue that cannot be classifiedclinically and pathologically under any other disease#

Etiology 8 ;nkno0n#

"linical %eatures

,t appears as a usually asymptomatic fiery red 0elldemarcated pla'ue 0ith a smooth and !el!ety surface# $he redlesions may be associated 0ith 0hite spots or small pla'ues#$he floor of the mouth retromolar area soft palate andtongue are the most common sites of in!ol!ement#&rythroplakia occurs more fre'uently bet0een the ages of = years# O!er ?@ of erythroplakias histologicallydemonstrate se!ere dysplasia carcinoma in situ or earlyin!asi!e s'uamous(cell carcinoma at the time of diagnosis#

Laboratory tests +istopathological e"amination#

i%%erential diagnosis &rythematous candidiasis lichen

Erythropla&ia


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&rythroplakia of the lateralmargin of the tongue

&rythroplakia of thebuccal mucosa#


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e%inition )lasma(cell gingi!itis is a rare and uni'ue

gingi!al disorder characterized histopathologically by adense chronic inflammatory infiltration of the laminapropria mainly of plasma cells#

Etiology ;nkno0n# Reactions to local allergens chronicinfections and plasma(cell dyscrasias ha!e been considered

as possible causes#

"linical %eatures *linically both freeand attached gingi!aare bright red and edematous 0ith a loss ofnormal stippling#$hegingi!itismay be localized or 0idespread and isfre'uently accompanied by a burning sensation# Rarelysimilar lesions may be seen on the tongue and lips#

Laboratory tests +istopathological and histochemicale"amination immunoelectrophoresis#

i%%erential diagnosis Des'uamati!e gingi!itis psoriasiscandidiasis soft(tissue plasmacytoma erythroplakia

'lasma$"ell Gingi(itis


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)lasma(cellgingi!itis

" All i ! i i


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e%inition *ontact allergic stomatitis is arare acute or chronic allergic reaction#

Etiology Denture base materialsrestorati!e materials mouth0ashesdentifrices che0ing gums foods and othersubstances may be responsible#

"linical %eatures *linically in the acute

form the affected mucosa presents 0ithdiffuse erythema and edema andoccasionally small !esicles and erosions# Aburning sensation is a common symptom# ,nthe chronic form hyperkeratotic 0hitelesions may be seen in addition toerythema#

Laboratory tests Mucosal and skin patchtests#

i%%erential diagnosis Denture stomatitiserythematous candidiasis erythroplakia

Allergic stomatitiscaused by acrylicresin

"ontact Allergic !tomatitis


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e%inition +emangioma is a relati!ely common benignproliferation of blood !essels that primarily de!elops duringchildhood#

Etiology De!elopmental#

"linical %eatures $0o main forms of hemangioma arerecognized8capillary and cavernous. $he capillary formpresentsas a flat red area consisting of numerous small capillaries#*a!ernous hemangioma appears as an ele!ated lesion of a deep

red color and consists of large dilated sinuses filled 0ithblood CFig# E# A characteristic sign of hemangioma is thatthe red color disappears on pressure and returns 0hen thepressure is released#

Laboratory tests +istopathological e"amination#

i%%erential diagnosis )yogenic granuloma lymphangioma

)emangioma


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*a!ernous hemangioma


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e%inition* Lupus erythematosus is a chronicimmunologically mediated disease#

Etiology* Autoimmune#

"linical %eatures* $0o main forms of the disease arerecognized8 discoid CDL& and systemic CSL&# Oral lesionsde!elop in @


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Discoid lupus erythematosus8typical lesion on the buccal

mucosa


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"RE!T !yndrome*R&S$ syndrome is a clinical !ariant ofscleroderma characterized by a combinationof *alcinosis cutis Reynaud phenomenon&sophageal dysfunction Sclerodactyly and

$elangiectasia# $elangiectasia may occuron the lips and oral mucosa and presentsas red dots or pla'ues#

Treatment* Surgical e"cision or

cryotherapy or laser therapy# Somecapillary hemangiomas may regressspontaneously#


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*R&S$ syndrome8 lip telangiectasia


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)ereditary )emorrhagicTelangiectasia

e%inition* +ereditary hemorrhagic telangiectasia orOsler-Rendu-.eber disease is a rare mucocutaneousdisorder characterized by dysplasia of the capillariesand small !essels#

Etiology* ,nherited as an autosomal dominant trait#

"linical %eatures* $he oral mucosa is fre'uentlyin!ol!ed and the lesions present as multiple bright redpapules @-H mm in size 0hich disappear on pressurefroma glass slide# 1odules and spiderlike lesions mayalso be seen# +emorrhage is common after minimalmechanical damage# $he lips tongue buccal mucosa andpalate are most fre'uently in!ol!ed# &pista"is and

gastrointestinal bleeding are common# Laboratory tests* +istopathological e"amination#

i%%erential diagnosis* *R&S$ syndrome !aricositiesMaffucci syndrome multiple hemangiomas#

Treatment* Supporti!e#


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+ereditary hemorraghic telangiectasia8multiple lesions on the tongue


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Anemia)ernicious anemia iron deficiency anemiaand )lummer-9inson syndrome usually affectthe oral mucosa#

$he oral manifestations are early andcommon and are characterized by anatrophic smooth and red tongue# A burningsensation taste loss angular cheilitisand rarely erosions may be present#

$he differential diagnosis includesatrophic lichen planus and malnutritiondisorders# $he diagnosis is based onhematological laboratory tests#


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)ernicious anemia8 red and smooth dorsum of thetongue


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)lummer-9inson syndrome8 redness and atrophy ofthe lingual papillae associated 0ith angular

cheilitis

Thrombocytopenic


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Thrombocytopenic'urpura

e%inition* $hrombocytopenic purpura is a hematological disordercharacterized by a decrease in platelets in the peripheral blood#

Etiology* )resumably a nonspecific !iral infection myeloto"icagents#

"linical %eatures* $he oral manifestations consist of red lesionsin the form of petechiae ecchymoses or e!en hematomas usuallylocated on the palate and buccal mucosa# Spontaneous gingi!albleeding is a constant early finding# )urpuric skin rashepista"is and bleeding from the gastrointestinal and urinarytract are common#

Laboratory tests*)eripheral platelet count bone(marro0aspiration bleeding and clotting times#

i%%erential diagnosis* Aplastic anemia leukemias polycythemia!era agranulocytosis macroglobulinemia drug reactions#

Treatment* Steroids platelet transfusions cessation of drug

treatment if it is drug(related#


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,diopathic thrombocytopenic purpura8

petechiae and ecchymoses of the buccalmucosa

In%ectious


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In%ectiousMononucleosis

e%inition* ,nfectious mononucleosis is an acute self(limitedinfectious disease that primarily affects children#

Etiology* &pstein-4arr !irus transmitted through sali!a transfer#

"linical %eatures* $he oral manifestations are early and commonand consist of palatal petechiae u!ular edema tonsillare"udate gingi!itis and rarely ulcers# %eneralizedlymphadenopathy hepatosplenomegaly maculopapular skin rash andsore throat are common# )rodromal symptoms such as anore"iamalaise headache fatigue andlater fe!er occur before theclinical manifestations#

Laboratory tests* +eterophile antibody tests and other specificantibody tests C)aul-4unnell test monospot test#

i%%erential diagnosis* Leukemias secondary syphilisdiphtheria fellatiothrombocytopenic purpura traumatichematoma#

Treatment* Symptomatic#


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,nfectious mononucleosis8 petechiae on thepalate


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iagnosis

1ecessary to take a blood pictureCincluding blood and platelet count and

assess haemostatic function or e"clude!itamin deficien( cies and7oraspiration biopsy or imaging may beindicated


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"ase Report +;ni!ersity of Manitoba *ase Study


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I


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ay ,-

Antibiotics 0orked

but still sore

1ystatin for H 0eeks

ay ./

Symptoms still not

impro!ed

1ystatin

ay 0-

;lcer noted along0ith 0hite and red

patches

)atient complained ofpain

;ni!ersity of Manitoba


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ay 1.

Symptoms had becomeprogressi!ely 0orse

)ain kept her up atnight and felt thattongue 0as s0ollen#

Lesion more than H cm0ith a @(cm ulcer

centrally located4iopsy

ay 2-

4iopsy resultsconfirmed s'uamous cellcarcinoma

;ni!ersity of Manitoba


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"ase Report 3Denture Stomatitis8 *ase Report by )anat et al#


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= y7o Male

Difficulty ineating due tobroken denture

Associated 0ithmild burningsensation since @


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In(estigations

*ytosmear8 1umerous

*andidal hyphae

Routine bloodin!estigationC+ematinic R4%

ManagementDiscontinuation ofdenture use /refabrication

*andid gumpaint " tds "H7


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"ase Report ,S** 8 A *ase Report by $yagi H=@I


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= y7o Female

)ainful non healingulcer in the lo0eranterior region ofthe 2a0 since a year

ago

%radual increase inthe size

On medication forathritis

Does not che0 orsmoke tobaccoconsume alcohol

$yagi H=@I# S'uamous cell carcinoma C0ell(differentiated 8 A case report#Kournal of Dentistry and Oral +ygiene


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Intra$oral E4amination

I Icm o!al shaped

single ulcer present onthe mandibular ridge inthe canine(premolarregion

;lcer had irregular

margins and underminededges

4ase and borders 0erefirm on palpation

Floor of the ulcer 0aserythematous 0ithpresence of bleeding

$ender on palpationand bleeding 0as presenton slightest pro!ocation#



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iagnoses

)ro!isional8 S**

Differential8,nflammatoryhyperplasianecrotizingsialometaplasia

In(estigations

Acid fast bacilliCAF4 stain

,ntraoral periapicalradiograph of tooth inregion

+aematologicalin!estigations

,ncisional biopsy81umerous keratin pearlsand fe0 mitotic figures0ith cellular andnuclear pleomorphismand hyperchromatism



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"ase Report .


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I y7o Male

Lesion on anteriorlabial mucosa

)atient said lesionchanged shapesize area positionand disappeared andreappeared o!ertime

Intra$oral E4amination

Asymptomatic

bilateral smootherythamatous lesion0ith defined marginsbelo0 le!el of attachedgingi!a appro"imately@(H cm

Documents

Differential Diagnoses of Red Lesions