Linear IgA disease histopathologically and clinically masquerading as lichen planus

Recurrent oral ulceration: Etiology, classification, management, and diagnostic algorithm

Recurrent oral ulcerations are manifestations of a heterogeneous set of both general and more-or-less specific oral diseases due to numerous potential etiologies, including, but not limited to, infections, medications, autoimmune disease, and other systemic disease. This review discusses the pathogenesis, clinical presentation, diagnosis, and management of the common causes of recurrent oral ulceration. The following types/etiologies of recurrent oral ulceration are covered: traumatic ulceration, chemical ulceration, recurrent aphthous stomatitis, medication-related ulceration, infectious ulceration, mucocutaneous disease, and autoimmune/systemic disease. A diagnostic algorithm for recurrent oral ulceration is also presented.

Linear IgA bullous dermatosis mimicking oral lichen planus

Linear IgA bullous dermatosis (LABD) is an autoimmune disease characterized by blisters on the skin and mucous membranes. Polycyclic, grouped bullae on cutaneous skin are the most characteristic clinical feature of LABD. Lesions are often indistinguishable from bullous pemphigoid or may resemble dermatitis herpetiformis. Oral lesions may be seen in 5% to 70% of patients with LABD, and in some cases, the oral mucosa may be the only area of involvement. Herein, we report a patient with LABD involving only the oral mucosa clinically. The entity histologically mimicked oral lichen planus, which challenges accurate diagnosis and emphasizes the importance of direct immunofluorescence.

Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree

Diagnosis of oral ulcerative lesions might be quite challenging. This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. Various general search engines and specialized databases including PubMed, PubMed Central, Medline Plus, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “oral ulcer,” “stomatitis,” and “mouth diseases.” Thereafter, English-language articles published since 1983 to 2015 in both medical and dental journals including reviews, meta-analyses, original papers, and case reports were appraised. Upon compilation of the relevant data, oral ulcerative lesions were categorized into three major groups: acute, chronic, and recurrent ulcers and into five subgroups: solitary acute, multiple acute, solitary chronic, multiple chronic, and solitary/multiple recurrent, based on the number and duration of lesions. In total, 29 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by stepwise progression.

Successful treatment of oral linear IgA disease using mycophenolate

Linear IgA disease (LAD) is a rare acquired autoimmune bullous disorder, characterized by linear deposition of IgA along the dermoepidermal basement membrane zone. The clinical presentation of LAD consists of vesiculobullous lesions affecting the skin and mucosal surfaces. The present case report presents a rare presentation of this vesiculobullous disorder. Although more than 50% of LAD patients present with oral lesions, there are few reported cases of involvement of the mouth as the sole manifestation. A 79-year-old female presented with a sore mouth and erosions affecting the palate. The symptoms resolved following the provision of mycophenolate, an antiproliferative immunosuppressant which has not previously appeared to have been reported in the long-term successful management of linear IgA disease limited to the mouth. We found that mycophenolate is a useful adjunct to the successful treatment of oral linear IgA when the uses of other immunosuppressants are contraindicated.

Use of Anti-Inflammatory Medications in Managing Atypical Gingivitis Associated With Hypermobile Ehlers-Danlos Syndrome: A Case Report

BACKGROUND

Ehlers-Danlos syndrome (EDS) is a group of collagen disorders primarily affecting the skin and joints. This case report describes the periodontal management of a case of hypermobile EDS (type III) associated with atypical gingivitis.

METHODS

A 17-year-old Caucasian female with a history of EDS type III presented with erythematous mucogingival lesions. An incisional biopsy was taken. The treatment objective was to control the mucogingival inflammatory lesions. Plaque control measures were followed with anti-inflammatory medications. Prednisone was administered systemically for 3 weeks (first week: 30 mg/day, second week: 15 mg/day, and third week: 5 mg/day), and was followed with topical applications of clobetasol (0.05%) twice daily for 2 weeks. Persistent marginal gingival inflammation was managed with a 3-month course of doxycycline (20 mg) twice/day. The patient was placed on a 3-month maintenance program and monitored for over a year

RESULTS

Histopathology showed multiple granulomas enclosing fragments of crystalline foreign material. Steriodal anti-inflammatory medications partially reduced the size and intensity of the mucogingival lesions. Doxycycline controlled the residual marginal inflammation. A 3-month maintenance interval helped in maintaining the results obtained.

CONCLUSIONS

The collagen disorder may have facilitated the introduction and lodging of foreign material within the gingival tissues, initiating a foreign body reaction. Poor healing associated with EDS excluded surgical excision and necessitated the use of anti-inflammatory medications. A combined approach of plaque control measures along with anti-inflammatory medications was helpful in controlling the mucogingival inflammatory lesions associated with this condition.

Diagnosis of periodontal manifestations of systemic diseases

Many systemic diseases can mimic periodontitis or gingivitis. These include many immunologic, infectious, neoplastic and metabolic disorders. In comparison with periodontitis and gingivitis, these disorders are considerable less common. However, since their diagnosis and management differ, a high index of suspicion is frequently needed when confronted a patient presenting with gingival or periodontal disease. This chapter has reviewed a number of systemic conditions that may mimic clinically both gingivitis and chronic periodontitis and has focused on the features that may assist the clinician in making the diagnosis and providing specific therapies.

Two cases of linear IgA disease with clinical manifestations limited to the gingiva

Linear IgA disease (LAD) is a chronic, subepithelial blistering disease that is associated with the presence of linear deposits of IgA along the basement membrane zone. Etiopathogenic aspects of LAD are only partially known. LAD is clinically characterized by vesiculobullous skin and mucous lesions. Although more than half of LAD patients present oral mucosal lesions, there are only a few cases reported of oral lesions as the only manifestation of LAD. This study presents 2 of these uncommon cases.

Vancomycin-associated linear IgA bullous dermatosis mimicking toxic epidermal necrolysis

Vancomycin is the most frequent trigger of drug-induced linear IgA bullous dermatosis. We describe a fulminant case of linear IgA bullous dermatosis in a 74-year-old man who experienced skin sloughing of 90% of his body surface after receiving vancomycin.

Management of oral lichen planus

Lichen planus is a relatively common disorder of the stratified squamous epithelia. Most dental and medical practitioners see patients with lichen planus, but not all are recognized as having the disease. Patients with lichen planus may have concomitant involvement of the disease in multiple sites. Oral lichen planus lesions usually have a distinctive clinical morphology and characteristic distribution, but oral lichen planus may also present a confusing array of patterns and forms, and other disorders may clinically mimic oral lichen planus. The etiopathogenesis of lichen planus appears to be complex, with interactions between genetic, environmental, and lifestyle factors. Much has now been clarified about the etiopathogenic mechanisms involved and interesting new associations, such as with liver disease, have emerged. The management of lichen planus is still not totally satisfactory in all cases and there is as yet no definitive treatment that results in long term remission, but there have been advances in the control of the condition. Amongst the many treatments available, high potency topical corticosteroids remain the most reliably effective, though topical cyclosporine, topical tacrolimus, or systemic corticosteroids may be indicated in patients whose condition is unresponsive to topical corticosteroids.