Oral and Dermatological Lesions: Clinical Insights
Oral Candidiasis
- Pseudomembranous Candidiasis (Thrush): Characterized by white, "skim milk" like pseudomembranes.
- Erythematous Oral Candidiasis: Presents as red, erythematous areas, often a sequel to thrush.
- Chronic Hyperplastic Candidiasis: Appears as persistent white plaques, commonly seen in older patients with acrylic prostheses.
- Chronic Atrophic Oral Candidiasis: Associated with acrylic prostheses (e.g., upper suction chamber dentures), presenting as red, atrophic mucosa.
Mucocutaneous Inflammatory Conditions
- Lichen Planus:
- Can present as reticular (thorny/lace-like), papular, or erosive lesions.
- Potentially premalignant, especially the erosive form.
- Clinical presentation includes white or violet lesions on the buccal mucosa and gingiva.
- Psoriasis (Skin Lesions):
- Characterized by pink-salmon plaques covered with silvery scales.
- Removal of scales reveals bleeding points (Auspitz sign).
- Stress can exacerbate symptoms.
Benign Tumors and Proliferations
- Keratoacanthoma:
- Rapidly growing tumor originating from hair follicles or sebaceous glands.
- Abrupt onset, often spontaneously regresses.
- Presents as a nodule with a central keratin plug or crater.
- Condyloma Acuminatum (Genital Warts):
- Caused by Human Papillomavirus (HPV).
- Can manifest as oral lesions, potentially transmitted via saliva.
- Often presents as multiple, verrucous lesions.
- Verruca Vulgaris (Common Wart):
- Typically presents as 1-3 nodules.
- Can occur on the ventral surface of the tongue or lips.
- Pyogenic Granuloma:
- Chronic Pyogenic Granuloma: Inflamed gingiva, tongue mucosa, and buccal mucosa, appearing as red, bleeding, or yellowish nodular areas.
- Pyogenic Granuloma of Pregnancy (Pregnancy Tumor): Hormonally induced, localized lesion, often associated with generalized gingivitis during pregnancy.
- Parulis (Gum Boil) related Pyogenic Granuloma: An inflammatory lesion originating from pus discharge via a chronic dentoalveolar abscess fistula, often associated with a localized tooth abscess.
- Pulp Polyp (Hyperplastic Pulpitis):
- Common in molars of young children.
- Proliferates, forming granular pulp tissue.
- Usually asymptomatic.
- Treatment often involves extraction or endodontic therapy.
- Irritation Fibroma (Pseudo-Fibroma):
- Often caused by chronic irritation (e.g., biting).
- Presents as an ulcerated, keratotic, or nodular area, commonly on the inner cheek.
- Differential diagnosis includes a true fibroma.
- Traumatic Neuroma (Amputation Neuroma):
- A soft, often painful nodule.
- Results from the proliferation of Schwann cells attempting to regenerate a severed nerve, but unable to form a functional connection.
- Peripheral Giant Cell Granuloma (Reactive Lesion):
- Often occurs at extraction sites, especially where a bone spicule remains.
- Can be associated with ill-fitting prostheses.
- Typically red-wine in color.
- True Fibroma:
- Normal color, often keratinized.
- Slow-growing.
- Differential diagnosis includes irritation fibroma, which is often red and inflamed.
- Giant Cell Fibroma:
- Can occur on any oral mucosa, frequently on the anterior third of the tongue.
- Asymptomatic with a long evolution.
- General Fibroma Characteristics:
- Some fibrous lesions can be long-standing, firm, and immobile.
- May be found on the maxillary skin.
- Peripheral Ossifying Fibroma:
- Originates from periosteum or periodontal ligament cells.
- Affects adults and young children.
- Histologically, it may contain bone (ossifying) or cementum (cementifying) within a fibrous capsule.
- Immature forms are termed 'immature ossifying fibroma' or 'immature cementifying fibroma'.
Nerve Sheath Tumors
- Neurilemoma (Schwannoma):
- Benign neoplasm of Schwann cells.
- Commonly found on the tongue.
- Firm, hard, movable, and typically white or pink.
- Histologically characterized by Antoni A (palisading Schwann cells forming Verocay bodies) and Antoni B areas.
- Multiple Neurilemomas/Schwannomas:
- Often associated with Neurofibromatosis Type 1 (Von Recklinghausen's disease).
- More common in men.
