pemphigoid: IgA and IgG autoantibodies target epitopes on both intra- and extracellular domains of bullous pemphigoid antigen 180. Br J Dermatol 2001;145:778–783.
Wojnarowska F, Kirtschig G, Khumalo N. Treatment of sub-epidermal immunobullous diseases. Clin Dermatol 2001;19:768–777.
Cinnamon Contact Stomatitis
Cinnamon contact stomatitis is a relatively common reaction of the oral mucosa secondary to the chronic use of substances with artificial cinnamon flavoring.
The stomatitis is a result of use of cinnamon products such as chewing gum, candy, toothpaste, dental floss, oral solutions etc.
•Redness of the oral mucosa usually associated with desquamation and erosions or ulcerations
•Hyperkeratotic white plaques are common
•Burning and pain are common symptoms
•Buccal mucosa and the lateral borders of the tongue are more frequently affected
•Exfoliative cheilitis and perioral dermatitis may occur
The diagnosis is based on the history and the clinical features.
•Amalgam contact stomatitis
•Chronic biting
•Leukoedema
•Lichen planus
•Leukoplakia
•Candidiasis
•Hairy leukoplakia
•Plasma cell stomatitis
•Uremic stomatitis
•Lupus erythematosus
•Epithelial peeling
Basic Guidelines
•High level of oral hygiene should be maintained.
•Change or avoid any product which contains cinnamon.
•Avoid antibacterial mouthwashes as these worsen the symptoms.
•If the cinnamon products are reused usually the signs and symptoms soon recur.
Suggested Therapies
•Discontinuation of any cinnamon product improves the condition and the signs and symptoms disappear in approximately 2 weeks time.
•In cases of severe and extended erosions, corticosteroids in the form of topical ointment or low doses of oral prednisone, e.g., 10-15 mg/day for 1 week, help the lesions to heal soon.
•Topical rinses with chamomile four to five times daily improve the symptoms.
References
Allen CM, Blozis GG. Oral mucosal reactions to cinnamon-flavored chewing gum. JADA 1988;116:664–667.
Le Sueur BW, Yiannias JA. Contact stomatitis. Dermatol Clin 2003;21:105–114.
Miller R, Gould A, Berstein M. Cinnamon-induced stomatitis venenata. Oral Surg Oral Med Oral Pathol 1992;73:708–716.
Samio EL, Kanerva L, Contact allergens in toothpastes and a review of their hypersensitivity. Contact Dermatitis 1995;33:100–105.
Coccidioidomycosis
Coccidioidomycosis is a chronic systemic mycosis, endemic in the USA. Central America, and South America.
Coccidioides immitis, a dimorphic fungus, is the causative organism.
There are five clinical forms of the disease: a) acute pulmonary, b) chronic pulmonary, c) disseminated focal, d) disseminated widespread, and e) meningitis. Oral lesions develop in disseminated infection, which commonly occurs in patients with AIDS or in immunocompromised patients.
Oral Lesions
These present as vegetating ulcers with irregular peripheries. The palate, tongue, and gingiva are more frequently affected.
Disseminated Widespread Form
Fever, malaise, anorexia, cough, chest pain, weight loss, and lymphadenopathy are common signs and symptoms. With time, lesions develop in the bone, joints, skin, subcutaneous tissues, meninges, and other sites.
Smear, culture, and biopsy are very useful diagnostic tools. Serologic tests are also helpful.
•Paracoccidioidomycosis
•Other systemic mycoses
•Squamous cell carcinoma
•Tuberculosis
•Syphilis
•Non-Hodgkin lymphoma
•Leishmaniasis
Basic Guidelines
These are as for the other systemic mycoses.
Suggested Therapies
•Itraconazole
