Red Lesions Flashcards
Red – NON-Vascular
Traumatic Erythema
Oral Candidiasis
◦ Denture/appliance stomatitis
◦ Central Papillary Atrophy
◦ Acute Atrophic Candidiasis
◦ Angular Cheilitis
◦ Chronic Multifocal
Thermal Burns
Erythoplakia
Orofacial Granulomatosis
Traumatic Erythema
Irritation of the mucosa that results in erosion of surface layer
Red macule with irregular margins and typically tender to the
touch
Lesion does NOT blanch with pressure
Can occur most any place and is typically associated with
trauma or irritant exposure
TX: Palliative treatment, will typically resolve in a week
◦ If not, will require follow-up to ensure not systemic involvement or constantly retraumatizing site
◦ Must r/o child abuse
Appliance Stomatitis
Asymptomatic, red lesion that appears
underneath an appliance, space maintainer,
retainer or flipper device that is ill-fitting or not
removed or cleaned as directed
Candida and/or bacteria can typically cause the
reaction
Should self resolve in healthy individual with
improved hygiene of device
Device should be worn minimal for 2 weeks and
then reassessed, may need antifungals if not
resolve
Central Papillary Stomatitis
Median Rhomboid Glossitis
Also known as Central Papillary Atrophy
Found in midline, posterior aspect of tongue with rhomboid shape
Lingual papillae are absent in area of glossitis/red
In children, likely related to inhaled corticosteroids related to
asthma
Chronic fungal infections (Oral candidiasis) is frequently
associated
May see matching lesion on the palate
Antibiotics and inhaled corticosteroids are commonly associated
Acute Atrophic Candidiasis
Located on dorsum of the tongue, palate or buccal
mucosa
Painful and raw to the touch
Depapillated areas can be seen on the dorsum of the
tongue
Can occur with angular cheilitis at the same time
Typically caused by antibiotics and iron deficiency
Cessation of the antibiotic, increased iron intake (Need
CBC), and removal of insulting factors should allow for
resolution
Angular Cheilitis
Patients taking Depakote (Seizure disorder) can lead to excessive
salivation and cause angular cheilitis
Occurs at the commissures of the lips
In younger patients, result from lip licking, chapped lips, excessive
moisture pooling and then skin breakdown
Older adults are due to collapse of VDO and leading to saliva
pooling and skin breakdown
Secondary bacterial (staph) infections can occur
Typically treated with topical antifungal and change in habits
If not resolving, secondary bacterial infection may be present
Thermal Burns
Typically a result of thermal burn from pizza, soup, hot beverage
Palate and tongue are most common locations
Chemical burn can result from formocresol, acid etch, ferric sulfate
Typically occurs on skin (perioral), gingiva, buccal or labial mucosa
Appears as irregular shaped necrotic patch that wipes off and reveals
red erosive area
RX: Palliative, allow it to heal and typically resolves in a few days:
Neosporin for perioral/skin lesion
Possibly due to cinnamon or dentifrice, but more diffuse
Erythoplakia
Red, velvety, eroded area that may appear to have a
depression on the surface
Typically occurs in area of thin or atrophic epithelium and
increased vascularity
Can be caused by local irritants, but higher likelihood vs.
leukoplakia to be more dyplastic
Histologically will have increased vascular dilation
Orofacial Granulomatosis
Encompasses a larger umbrella of clinical presentations with non-specific granulomas present
Aphthous stomatitis is common, but no specific trigger
Patient may have multiple underlying allergies (Food mainly)
Systemic disease must be ruled out as well: Crohn’s, sarcoidosis, tuberculosis
Typically found in adults, but children may exhibit signs and symptoms associated with
gastrointestinal inflammation
Clinical has wide array of presentations
Lips are most commonly involved
◦ Tongue and gingiva may also have diffuse swelling and erythema
Treat with allergen elimination and topical steroids as needed
Granulomatous disease due to abnormal immune
response/reaction
Food allergens are typical trigger in children
◦ Likely have GI issues underlying
Lip, tongue, buccal mucosa and gingiva are common
Persistent swelling, erythema, cobblestone pattern, fissured
tongue
TX: Incisional biopsy to confirm DX, identify the allergen and
then steroids
◦ Has been treated with LLLT (Low Level Laser Therapy)
Possible Crohn Disease
Red - Vascular
Diascopy + = Blanch under pressure → Blood within vessel
◦ Hemangioma / Vascular malformation
◦ Sturge-Weber Syndrome
◦ Hereditary Hemorrhagic Telangiectasia
Diascopy - = Does NOT blanch under pressure → No blood in vessel
◦ Submucosal hemorrhage
◦ Petechiae
◦ Ecchymosis
◦ Hematomas
◦ Thrombocytopenia
◦ Infectious Mononucleosis
◦ Kaposi’s sarcoma
Hemangioma
Infantile hemangioma is the most common tumor of infancy
Proliferation phase begins in the first 2 weeks of life and persists for the first year of life
For the following 7-10 years, the proliferation stales and involutes
20% can lead to destruction of normal tissue
Unclear/unknown etiology
Can be treated with beta blockers to reduce proliferation
Sturge-Weber Syndrome
Congenital port wine stains of upper face and forehead
◦ Lesion is present at birth
Leptomeningeal angiomas
Ipsilateral facial angiomatosis typically is present
May be associated with learning disabilities, seizures, strokes and
ocular defects
Intraorally may present with pyogenic granulomas, gingival hyperplasia,
alveolar bone loss and diffuse vascular lesions within mouth
Areas effected are closely related to areas innervated by the trigeminal
nerve
Hereditary Hemorrhagic Telangiectasia (HHT)
Also known as Osler-Weber-Rendu Syndrome
Autosomal dominant disorder, 1 in 7,000 persons
Multiple dilated capillaries (Telangiectasia) of the skin and mucosal
membranes
Lesion WILL blanch with pressure (Diascopy +)
AV (arteriovenous) fistula of lung, liver and brain put patient at
higher risk for infection/abscess
Commonly occur with oral bleeding and epitaxis (Nose-bleeds)
MAY NEED SBE, if patient has associated AV malformation of
another organ system!
Submucosal Hemorrhage
Also commonly called petechiae, purpura, ecchymosis, hematoma
Petechiae: Pinpoint
Purpura: 2mm to 2cm
Ecchymosis: >2cm
Submucosal Hemorrhage
Results from entrapment or pooling of blood in tissue
Does NOT blanch with pressure (depending on location, can use microscope slide to
visualize)
Typically result from trauma to area or impact in surrounding area
Non-traumatic events can be related to blood dyscrasia, viral infection
(measles/infectious mononucleosis) or anticoagulant medicine
Found with high frequent (42.8%) of children with systemic disease
