Lilly GE, Clinical, historic, and therapeutic features of aphthous stomatitis. Oral Surg Oral Med Oral Pathol 1992;74:79–86.
Woo SB, Sonis ST. Recurrent aphthous ulcers: A review of diagnosis and treatment. JADA 1996;127:1202–1213.
Ariboflavinosis
Ariboflavinosis or vitamin B2 deficiency is an unusual disorder that usually occurs in combination with other vitamin deficiencies.
Deficiency of vitamin B2 occurs due to dietary inadequacy, achlorhydria, malabsorption, alcoholic cirrhosis, hypothyroidism, and drugs.
Oral Manifestations
•Angular cheilitis
•Atrophy of the filiform papillae resulting in a smooth red tongue
•Dry and cracked lips
Other Manifestations
•Skin lesions include perioral seborrheic dermatitis, scaly papules, fissures, and, rarely, ulcers
•Conjunctivitis and photophobia
•Anemia, mental disorders, and slowing of higher functions: weakness may occur
The diagnosis is based mainly on the medical history and clinical features. Biochemical analysis of vitamin B2 status and measurement of erythrocyte glutathione reductase helps confirm the diagnosis.
•Pellagra
•Plummer-Vinson syndrome
•Other vitamin B complex deficiencies
•Zinc deficiency
•Angular cheilitis
Basic Guidelines
•Improve or treat any underlying illness.
•Eat foods rich in vitamin B2 (meat, fish).
Suggested Therapies
•Treatment consists of riboflavin 5-15 mg/day taken orally until the clinical signs and symptoms are resolved. In severe cases 2-4 mg two times daily can be given parenterally.
•Topical antifungals such as nystatin or miconazole ointment may be used for the treatment of angular cheilitis.
•A high level of oral hygiene is necessary.
Barthelemy H, Chouvet B, Cambazard F. Skin and mucosal manifestations in vitamin deficiency. J Am Acad Dermatol 1986;15:1263.
Mataix J, Aranda P, Sanchez C, et al. Assessment of thiamin (vitamin B2) status in an adult Mediterranean population. Br J Nutr 2003;90:661–666.
Miller SJ. Nutritional deficiency and the skin. J Am Acad Dermatol 1989;21:1–30.
Roe DA. Riboflavin deficiency: Mucocutaneous signs of acute and chronic deficiency. Semin Dermatol 1991;10:293–7.
Aspergillosis
Aspergillosis is an opportunistic fungal infection with a broad spectrum of clinical manifestations.
Aspergillus fumigatus and A. flavus are the main pathogenic Aspergillus species. Immunocompromised patients such as those with HIV infection, neutropenia, leukemia, and diabetes, those receiving immunosuppressant agents and organ transplantation, and patients with chronic respiratory diseases are more susceptible to Aspergillus infection.
There are several types of Aspergillus infection: a) allergic aspergillosis, b) aspergilloma (fungus balls), c) invasive aspergillosis (pulmonary involvement in 90-95% and extrapulmonary involvement in 20-25%), d) chronic necrotizing pulmonary aspergillosis, and e) superficial aspergillosis with skin, ear, and eye involvement.
The oral mucosa is usually affected in invasive pulmonary aspergillosis. Rarely, the oral lesions are the initial manifestation of the disease.
Oral Manifestations
The oral lesions present as irregular ulcers with a typical yellowish-black surface due to necrosis of the tissues. The lesions are usually localized to the palate, tongue, and lips
Invasive Pulmonary Aspergillosis
Fever, cough, dyspnea, retrosternal and pleuritic pain, and tachycardia are the most common symptoms and signs. However, many patients with invasive pulmonary aspergillosis are asymptomatic
Oral lesions should be biopsied and histopatho-logically examined. A computed tomography (CT) scan of the chest for suspected pulmonary infection is recommended. Bronchoscopy, biopsy, and respiratory cultures can also be useful.
•Histoplasmosis
•Mucormycosis
•Cryptococcosis
•Other systemic mycoses
•Agranulocytosis
•Squamous cell carcinoma
•Non-Hodgkin lymphoma
•Malignant granuloma
•Wegener
