Granulomatous Disease

SARCOIDOSIS Sarcoidosis is a multisystem granulomatous disease with an uncertain etiology. The lungs, lymph nodes, skin, and eyes are affected most commonly. Skin lesions are common and include classic painless erythematous nodules, erythema nodosum, on the extremities. Oral involvement is primarily limited to enlargement of major and minor salivary glands, and xerostomia is a common complaint. Mucoceles of the minor salivary glands are common, and biopsy of these lesions may result in the diagnosis of sarcoidosis.19

WEGENER'S GRANULOMATOSIS Wegener's granulomatosis causes necrotizing lesions of the upper and lower respiratory tracts, kidney, and small arteries and veins. Any organ system can be involved. Orally, a distinctive form of gingivitis called strawberry gingivitis is seen. Originating from the interdental gingiva, strawberry gingivitis is characterized by a hyperemic granular hypertrophy of the gingival tissue. Eventually involving the entire gingiva and periodontal tissue, tooth mobility and loss are common. Poor healing at the site of tooth loss also occurs. Oral ulceration, jaw claudication, and temporomandibular joint arthralgia also may occur. Oral lesions are frequently the first manifestation of Wegener's granulomatosis. Since the disease is uniformly fatal without early detection and treatment, familiarity with this entity is important.1941

MYCOBACTERIAL INFECTIONS Most oral lesions of tuberculosis represent secondary infection from a primary pulmonary infection, but primary oral tubercular lesions can occur. Discovery of oral lesions prior to diagnosis of pulmonary tuberculosis is rare. Prior to effective antitubercular therapeutic regimens, oral lesions were considered a poor prognostic indicator. Secondary oral tubercular lesions are usually painful, irregular, nodular ulcers surrounded by an area of erythema affecting the tongue, lips, and palate most commonly. Lesions also may be leukoplakic. Primary lesions more commonly affect the gingiva. Tubercular osteomyelitis of the mandible is uncommon but has been reported.1 42

Oral lesions of lepromatous leprosy occur most commonly in the first 5 years of disease and are reported to affect up to 60 percent of patients. This is in contrast to tuberculoid leprosy, in which the oral cavity is rarely involved. The most commonly affected oral sites are the anterior maxillary gingiva, hard and soft palates, uvula, and tongue. In most patients, intranasal lesions precede oral involvement. Mucosal lesions may appear as yellowish sessile, enlarging nodules that may ulcerate and necrose with time. A pink or red discoloration of the maxillary incisors is the only specific dental finding. However, involvement of the maxilla in children can affect the development of teeth. Specific gingival involvement is limited to the premaxillary gingiva and is associated with underlying bony destruction and eventual loss of teeth.43

CROHN'S DISEASE Crohn's disease is an inflammatory disease that may affect the entire gastrointestinal tract from mouth to anus. A wide variety of oral lesions may be associated with Crohn's disease. The most common lesions are diffuse or nodular swelling of the oral and perioral tissue, a cobblestone appearance to the mucosa, and deep granulamatous ulcers surrounded by hyperplastic margins, fissuring on the midline of the lower lip. Oral lesions may be asymptomatic or painful. Additionally, angular cheilitis and submandibular lymphadenopathy can occur. Metallic dysguesia and gingival and buccal mucosal bleeding have been reported. Although these findings may be associated with any orofacial granulomatosis, it is important to note that the oral manifestations of Crohn's disease precede the gastrointestinal lesion in 30 percent of patients. 44

PYOGENIC GRANULOMA A pyogenic granuloma is a common, benign proliferation of connective tissue in a sessile or pedunculated manner in response to local trauma or irritation. It occurs primarily on the gingiva. Despite its name, this lesion is not a true granuloma but rather an accumulation of granulation tissue. A specific pyogenic granuloma occurring in pregnancy is referred to as a pregnancy tumor (F.j.g:. . . 234-12). This tumor is benign and usually recurs if removed during pregnancy. If the tumor does not regress 2 to 3 months postpartum, definitive removal is indicated. 45

FIG. 234-12. Pyogenic granuloma.

Collagen Vascular Disease

Collagen vascular diseases are a group of disorders that includes systemic lupus erythematosus and systemic sclerosis or scleroderma. They are immunologically mediated. Nearly a quarter of systemic lupus patients develop oral lesion affecting the palate, buccal mucosa, or gingiva. These lesions may be lichenoid in appearance with associated ulceration, pain, erythema, and hyperkeratosis.

Systemic sclerosis patients characteristically have microstomia secondary to perioral contractures as a result of the deposition of collagen in the perioral tissue. Limited mobility of the tongue and crenations of the buccal mucosa are common in severe disease. Trigeminal paresthesias and hyperesthesia are found in 4 percent of systemic sclerosis patients. Dental radiographs reveal a diffuse widening of the periodontal ligament space, and a panorex view in up to 70 percent of patients shows varying degrees of resorption of the posterior ramus, coronoid process, and mandibular condyles. 46

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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