Lecture 10 - Red-Blue Lesions PDF

Red-Blue Lesions Dr. Dilara Kazan Department of Oral&Maxillofacial Surgery Healthy chewing mucosa light pink, the covering mucosa is redder. • • • • Causes of abnormal redness vascular dilation extravasation of blood atrophy or erosion of the mucosa marked increase in the hemoglobin concentratio...

Red-Blue Lesions Dr. Dilara Kazan Department of Oral&Maxillofacial Surgery Healthy chewing mucosa light pink, the covering mucosa is redder. • • • • Causes of abnormal redness vascular dilation extravasation of blood atrophy or erosion of the mucosa marked increase in the hemoglobin concentration of the circulating blood Traumatic erythema • Reactive ulcers and conditions that cause chemical burns cause red lesions initially or if the causative agent is mild. hemangioma •Usually present at birth or at a young age •vascular neoplasms and vascular anomalies • congenital hemangioma: benign congenital neoplastic lesions which is originated from proliferating endothelial cells • vascular malformation:lesions involving abnormalities in vascular development However, the clinical and histological features of these lesions may show similarities. * Both types of lesions are red-blue in color. * They turn into white color when pressure is applied to them. * Especially in vascular malformations, blood stream can be felt with palpationand/auscultation. • Anywhere in oral cavity • Especially the tongue, lips and buccal mucosa • In the form of a large tumor, purplish-red, solitary or multiple Macule shaped bright red vascular malformations called ‘port-wine stain'→on the skin or gingiva, can be seen alone or as a symptom of the syndrome. When vascular malformations are present in the cerebral cortex and in one or more of the facial areas innervated by the trigeminal nerve, it is called Sturge-Weber syndrome. Various neurologic complications are seen in this condition. hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) • It is a rare autosomal dominant disorder. • Abnormal vascular dilatations are seen in the skin, mucous membranes and rarely in visceral organs. • Lesions are red macules or papules. Venous Varices • Abnormal vascular dilatation, common (especially in the elderly) • Bluish-red dilated veins on the ventral surface of the tongue • Bluish-red round shape with a diameter of 3-4 mm on the lower lip • Turns white in pressure Diagnosis • It can usually be recognized by clinical examination. • Honeycomb appearance is common in lesions located within the bone in the maxilla and mandible. • whitening on pressure dsitinguishes from hematomas and ecchymoses. • Angiography is useful in diagnosis and treatment planning. Treatment • There may be stabilization or regression in early childhood. • Since the borders of the lesions are not clear, their complete removal may not be possible. • Surgical treatments should be done very carefully. • Alternative treatments are selective embolization, sclerosing therapy and laser therapy. Pyogenic granuloma It consists of hyperplastic granulation tissue. It occurs mostly in the gingiva and is more common in women. etiological factor - A chronic irritation, usually associated with poor oral hygiene, restorations, calculus or foreign bodies. - Hormonal changes during pregnancy can also induce its formation. It is a small nodule that can grow up to a few centimeters. Generally, it is erythematous, soft, sometimes with necrotic surface. It emerges on both sides of an interdental papilla. It is purplish-red, bleeds with minimal trauma. • Clinical appearance and chronic trauma factor are helpful in diagnosis, definitive diagnosis is made by biopsy. • It is treated with surgical excision, but incomplete excisions and failure to eliminate the etiologic factor may cause recurrences. Peripheral giant cell granuloma It is a hyperplastic connective tissue response to injury of gingival tissues. - It is rare. - More common in women over 20 years of age. -It is more common in the gingiva between the 1st molars and incisors. In the edentulous crest, when it is in the form of a nodule or epulis-like growth, it usually involves the underlying bone and gives radiographic findings. Red, with a diameter of approximately 1 cm covered with a layer of yellowish fibrin. Diagnosis -It is clinically similar to pyogenic granuloma. If it has resorbed in the bone, it is more likely to be peripheral giant cell granuloma. -Diagnosis is made by biopsy. Treatment Excision. erythroplakia • It is a term that refers to a red patch on oral mucous membranes. Does not indicate a particular microscopic diagnosis. • Its etiology is unknown, but it is accepted that the factors that play a role or predispose to the formation of oral cancer are also valid for erythroplakia. • Erythroplakia are more likely to be premalignant or malignant than leukoplakia. This is especially the case in the floor of the mouth, tongue and retromolar region. • It is usually seen in individuals between 50-70 years of age. • Erythroplakia is clinically divided into homogeneous and speckled forms. • Homogeneous: uniform red, macule-shaped or magenta and may be slightly higher than the level of the mucosa. • Speckled: White areas between red areas • erythroplakia can be present anywhere in the mouth. • Diagnosis is by biopsy. • Treatment,is excision. Kaposi sarcoma • Its etiology is not known for certain, but viral etiology is emphasized. • It is common in patients with AIDS !!! • It is red-brown on the skin or red-blue in the oral mucosa. It can be in the form of a flat spot, or it can be nodular in shape. • Diagnosis is by biopsy; In patients with AIDS, the diagnosis is made by accompanying other AIDS findings. • Treatment, surgical treatment in localized lesions, low-dose radiotherapy, chemotherapy (intralesional/systemic) Drug Reactions Oral manifestations of the allergy may occur as a result of systemic or local contact with an allergen. • contact stomatitis(stomatitis venanata) - on the lips→as a result of a reaction to cosmetics such as lip balm/lipstick or suntan oil - Toothpaste and gums, antibiotic mouthwashes can be allergens. - Gold cast restorations with bad alloys can be allergic. • The buccal mucosa or tongue in contact with the restoration site is usually red and may have a burning sensation. • Allergy to dentures is very rare. If the reaction is only under the denture, it is not allergy but denture stomatitis. In true allergies, all areas in contact with the prosthesis, thus the labial and buccal mucosa are also affected. • Allergic stomatitis of systemic origin • It is usually due to medication (stomatitis medicamentosa) or food. • • • • • • • • • sulfonamides phenobarbitol penicillin streptomycin chloramphenicol tetracyclines hydantoin compounds phenylbutazone quinine • • • • • • oyster mussel chocolate hazelnut tomato citrus • The lips may be red, swollen, cracked or dry, and there may be a burning sensation. • In reactions to toothpaste or chewing gum, the gingiva may be diffusely red and edematous. • Some antibiotic mouthwashes or topical antibiotics can cause a reaction in the form of whiteness surrounded by a diffuse red area on the tongue or palate. • Allergic reactions to drugs and food may have systemic symptoms, but the reaction may also be limited to the oral cavity. The oral cavity is diffusely red in color. • In some cases of allergic stomatitis, lesions of other diseases may occur. These lesions include erythema multiforme, lichenoid eruptions and angioedema. • In some cases, diffuse erythema or vesiculobullous eruptions may occur. Diagnosis • Anamnesis of contact with the allergen is very important. • Biopsy (to show histological signs) • Response to treatment (If allergy is present, it will respond to antihistamines) • Skin testing, medical history and elimination diets • Allergies can be classified as early (six hours) and delayed (forty-eight hours) reactions. Treatment • The allergen should be identified and removed as soon as possible. • Early reactions respond to antihistamine treatment, late reactions: topical or systemic steroid treatment. Erythema multiforme • It is a self-limiting disease of the skin and mucous membranes. • In about half of the cases, no causative factor has been found. • Sometimes herpes simplex or mycoplasma pneumoniae may be the precipitating factor. Longterm sulfonamide and sulfa-containing hypoglycemic agents are also thought to be causative. There may also be symptoms such as fever and fatigue. • Lesions are usually found on the extensor surfaces, knees and palms. They start as red, circular lesions and then lighten in color in the center of the lesion. • In addition, there may be urticarial plaques, vesicles and bullae. • Intraoral red macules are found anywhere, especially on the buccal mucosa. • Characteristically, the lips are covered with a brownblack hemorrhagic crust. The lesions usually remain for 1-2 weeks, rarely lasting more than a month. • Stevens-Johnson syndrome is a more severe form or major variant of erythema multiforme. Fever, malaise, cough, chest pain, diarrhea, vomiting and arthralgia may be observed. The oral mucosa, lips and conjunctiva are most severely affected. • Diagnosis is based on clinical presentation. lupus erythematosus - chronic discoid lupus erythematosus - Systemic lupus erythematosus - The cause of both types is unknown. • In chronic discoid lupus erythematosus there is only skin involvement, while many organ systems are involved in the systemic form. • Chronic discoid lupus erythematosus It is characterized by the typical red, butterflyshaped rash on the bridge of the nose and cheeks. This rash can also appear on the forehead, scalp, ears, and malar area. • In mature lesions, peripheral erythema, a hyperkeratotic region in the middle, and atrophy in the center are seen. Lesions are usually on the upper part of the body. Lip lesions are red and margins may be silverywhite. • Oral lesions occur in half of the cases. • Oral lesions are mainly erythematous. • Ulceration, bleeding or red macules may contain white areas. • Tongue, palate and buccalmucous membranes are the most frequently affected areas. • Systemic lupus erythematosus has the same oral and skin lesions as chronic discoid lupus erythematosus. • In addition, fatigue is the most frequent and persistent complaint, especially in undiagnosed cases. Fever, arthritis or arthralgia, pericarditis, and many other complications are seen. • Diagnosis can be aided by the presence of characteristic skin lesions and/or systemic manifestations. Biopsy and direct immunofluorescence techniques confirm the diagnosis. • Treatment of chronic discoid lupus erythematosus may include avoidance of emotional stress, cold and sunlight. • Intralesional injection or application of corticosteroids over the lesions and systemic administration of quinine-containing drugs may be effective. Treatment is with systemic steroids and antimalarial drugs to eliminate skin manifestations. • The most important problem with these patients is the high doses of systemic steroids and their susceptibility to infection. Infection is the cause of death in about 20% of patients with systemic lupus. Petechiae and Ecchymoses • Petechiae (pinpoint-sized hemorrhages) and ecchymoses (larger hemorrhages) may appear in the mouth due to trauma or blood disorders. • Leukemias, platelet and clotting disorders can cause oral manifestations in the form of petechiae and ecchymoses. • When blood vessels are severely damaged, blood leaks into the surrounding connective tissue. • The result is red-purple lesions. The first signs of blood diseases can be seen in the mouth in this way. • Lesions become redder immediately after trauma and become purplish as time progresses. • The diagnosis is based on anamnesis, clinical examination and laboratory tests for hematologic diseases. • Petechiae and ecchymosis in areas that are normally unlikely to be traumatized, lesions that are not compatible with the severity of trauma, systemic symptoms such as lymphadenopathy, fever, weight loss, bleeding gums should suggest blood diseases. • Treatment and prognosis improve over time after the traumatic factor is removed. Systemic treatment is required for blood disorders.