Summer 2018 | Live Blog | Orocutaneous Disease: Review and Update
Dr. John Wright, an oral pathologist, presented an illuminating lecture on orocutaneous disease at the SDPA Annual Summer Conference. Dr. Wright began his talk with viral presentations of disease focusing on herpes simplex virus (HSV). Herpes simplex is a systemic virus which presents as a vesiculobullous disease. With primary herpes outbreak, it often presents panorally and symmetric. Dr. Wright reminded attendees that HSV is a “neurotropic” disease. Up to 70% of the population sheds HSV at least once a month. Furthermore, up to one third of patients have detectable HSV with PCR illustrating the importance of universal precautions in the approach to the oral cavity of patients.
Next, Dr. Wright discussed candidal presentations in the oral cavity. Atrophic forms of candidiasis as well as angular cheilitis were discussed. A useful clinical pearl regarding angular cheilitis is the importance of examining the palate where patients may have an underlying disease or disorder that needs to be treated in order to improve angular cheilitis.
Fun fact, geographic tongue is 4 times more frequent in patients with psoriasis.
Next, presentations of oral lichen planus were explored. The majority of erosive lichen planus lesions are found in the mucosa and gingival regions of the oral cavity. Furthermore, only 10% of patients with oral disease of lichen planus present with cutaneous disease.
Dr. Wright reported that there “is rarely anything in the clinical presentation that screams allergy” when patients present with an oral allergen. The most common allergen in patients who present with an oral hypersensitivity is cinnamon. Oral hypersensitivities to the mouth typically present with white lesions within the oral mucosa, particularly on the lateral tongue. Additionally, Dr. Wright reports that it is important to consider tartar control toothpaste when patients present with refractory hypersensitivity reactions.
Dr. Wright also discussed recurrent aphthous stomatitis as a common mucosal disorder of unknown etiology. Aptha with GI disorders typically present due to malabsorption within the presentation of inflammatory bowel disease.
Lastly, Dr. Wright touched upon the treatment of oral conditions with oral steroids, most of which are off label.
Byline: Sarah Patton, MSHS, PA-C
Posted: June 29, 2018