Oral Mucosal Diseases | Department of Dermatology

What is oral mucosal disease?

The oral mucosa is the mucous membrane lining or “skin” inside of the mouth, including cheeks and lips. People with oral mucosal diseases may develop painful mouth sores or ulcers on this lining.

Mucosal diseases can affect any mucous membrane. These membranes are also found inside the nasal passages, eyes, genitals and digestive tract.

Oral mucosal diseases can cause painful mouth problems.

What causes oral mucosal disease?

Oral mucosal diseases may have an autoimmune link, meaning the body’s immune system attacks healthy cells. Some mucosal diseases are inherited.

Our mucosal disease partners

Mucosal diseases can affect different parts of the body. We partner with other UC Davis specialists to provide comprehensive care. Depending on your unique situation, you may also see specialists in:

• Gastroenterology (digestive problems)
• Gynecology (women’s health)
• Ophthalmology (vision)
• Otolaryngology (ear, nose and throat disorders)
• Rheumatology (arthritis)

Oral mucosal diseases we treat

Your physician customizes a treatment plan based on disease type and symptoms. We treat all oral mucosal disease types, including:

• Behcet disease
• Burning mouth syndrome
• Oral lichen planus
• Pemphigus and pemphigoid
• Recurrent aphthous stomatitis
• Sjögren’s syndrome

Behcet disease

This rare condition inflames blood vessels throughout the body and can cause joint pain.

People with Behcet disease develop painful sores on the lips, tongue, cheeks, roof of the mouth, throat and tonsils. Sores also commonly occur on the genitals, eyes and skin. While the cause is unknown, the condition may be inherited or triggered by autoimmune disease.

In addition to clinical trial therapies, treatments include:

• Prescription mouthwash to relieve pain and discomfort
• Topical or oral corticosteroids to ease inflammation
• Immunosuppressants to help control the immune system and alleviate inflammation
• Selective phosphodiesterase 4 (PDE4) inhibitors (Otezla®) to treat oral ulcers 

Burning mouth syndrome

This condition causes a painful burning, scalding or tingling sensation in the mouth. Symptoms most often affect the tongue and lips. The problem does not cause blisters, but it can affect taste.

Burning mouth syndrome is more common in older women. Possible causes include:

• Anemia
• Chronic dry mouth
• Diabetes
• Medications
• Vitamin and other nutritional deficiencies

Treatments may include:

• Lifestyle modifications (dietary or medication changes)
• Oral and topical pain relievers
• Vitamin supplements
• Saliva substitutes and stimulants
• Medications such as benzodiazepines, tricyclic antidepressants and gabapentin

Oral lichen planus

This chronic condition inflames the mucous membranes of the cheeks, tongue, gums and esophagus. It can also affect the genitals and skin. People with this disorder develop red, swollen tissues and white, lacy patches on mucous membranes. Painful, burning sores may also develop.

The disease may be an autoimmune disorder and is most common in women over age 50. People with oral lichen planus have a higher risk of developing oral cancer, a type of head and neck cancer. For this reason, it is important to receive regular care from an oral lichen planus specialist. While there is no cure for oral lichen planus, the right treatments can ease symptoms and control the disease.

Treatments include:

• Topical or oral corticosteroids to reduce swelling
• Immunosuppressants to control an overactive immune system response
• Intravenous immunoglobulin (IVIG) antibodies therapy to fight infections

Pemphigus and pemphigoid

These rare autoimmune diseases cause fluid-filled blisters to form on the skin and in mucous membranes throughout the body. The blisters may cause painful itching or burning sensations. Extensive blistering can lead to fluid loss and infections.

We focus on treating your symptoms and putting the disease into remission. Treatments include:

• Antibiotics to treat infections
• Anti-inflammatory drugs to minimize swelling and inflammation
• B-cell therapy (Rituxan®) to destroy abnormal B cells
• Topical, injectable or oral corticosteroids to decrease inflammation and swelling
• Immunosuppressants to manage an overactive immune system
• Intravenous immunoglobulin (IVIG) therapy to generate antibodies that fight infection

Recurrent aphthous stomatitis

This condition causes painful, sometimes burning, blisters to form on the inside lining of the lips or mouth. It often develops during childhood.

People with aphthous stomatitis may have other conditions, such as:

• Behcet disease
• Celiac disease
• Human immunodeficiency virus (HIV)
• Inflammatory bowel disease

Treatments include:

• Prescription mouthwash to kill mouth bacteria and ease ulcer pain
• Topical, oral or injectable corticosteroid to decrease inflammation
• Immunosuppressants to slow the immune system’s response and reduce inflammation

Sjögren’s syndrome

This autoimmune disease affects saliva and tear production leading to dry mouth and eyes. The disorder is most common in women over 40. It can also cause:

• Digestive problems
• Dry skin
• Fatigue
• Joint pain

People with Sjögren’s syndrome often have other autoimmune diseases, such as rheumatoid arthritis or lupus. That’s why we partner with experts in our Rheumatology-Dermatology Clinic to manage all of your symptoms. Treatments may include:

• Artificial tear solutions to moisturize and soothe irritated dry eyes
• Saliva substitutes or stimulants to increase saliva production
• Over-the-counter pain relievers, such as ibuprofen and acetaminophen, to alleviate pain
• Anti-inflammatory drugs, including corticosteroids, to reduce swelling and inflammation
• Immunosuppressants to slow the immune system’s response and reduce inflammation
• Anti-rheumatics to treat rheumatoid arthritis pain and swelling

Contact us

To schedule an appointment, please call (800) 770-9282 or (916) 734-6111.

Lichen planus – NHS

Lichen planus is a rash that can affect different parts of your body, including the inside of your mouth. See a GP if you think you might have it.

Non-urgent advice: See a GP if you have:

• clusters of shiny, raised, purple-red blotches on your arms, legs or body (you may see fine white lines on the blotches)
• white patches on your gums, tongue or the insides of your cheeks
• burning and stinging in your mouth, especially when you eat or drink
• bald patches appearing on your scalp
• sore red patches on your vulva
• rough, thinning nails with grooves on
• ring-shaped purple or white patches on your penis

These are symptoms of lichen planus. You may only have 1 of these symptoms.

Lichen planus on your skin can be very itchy, but not always.

Lichen planus often appears on the inside of your wrist

Credit:

DR P. MARAZZI/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/259331/view

White patches in your mouth may be lichen planus

Credit:

DR P. MARAZZI/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/459302/view

If you’re not sure it’s lichen planus

Treatments from a GP

Lichen planus on your skin usually gets better on its own in about 9 to 18 months.

Creams and ointments from a GP can help control the rash and ease itching.

If creams and ointments do not work or you have severe lichen planus, steroid tablets or treatment with a special kind of light (light therapy) can help.

Lichen planus in your mouth can last for several years. Mouthwashes and sprays from a GP can help ease symptoms like burning or sore gums.

You cannot catch lichen planus and it does not usually come back once it’s cleared up.

For support and information, see UK Lichen Planus.

How to relieve lichen planus at home

If you have lichen planus on your skin:

• wash with plain warm water – avoid soaps and body washes
• wash your hair over a sink or bath so the shampoo does not come into contact with the rest of your skin
• use an emollient (moisturising treatment for the skin) on the rash

If the lichen planus is on your genitals:

• hold a bag of frozen peas wrapped in a clean tea towel against the affected bits to ease itching and swelling
• avoid wearing tights or close-fitting clothes

If you have it in your mouth:

• brush your teeth carefully twice a day to keep your gums healthy
• avoid salty, spicy or acidic foods if they make your mouth sore
• avoid alcohol and mouthwashes that contain it

Page last reviewed: 18 September 2020
Next review due: 18 September 2023

Changes in the oral mucosa with hypo

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The lack of vitamins has a very negative effect on the oral mucosa. With vitamin deficiency, the resistance of the oral mucosa to injuries, the effects of microorganisms decreases, and the processes of its regeneration slow down.

Vitamin deficiency is a disease that occurs when there is a deficiency of vitamins in food, and also if the vitamins that come with food are not absorbed from the intestines, or are intensively destroyed in the body. Depending on the degree of vitamin deficiency, beriberi and hypovitaminosis are distinguished. Avitaminosis is a severe form of vitamin deficiency that develops with a long-term absence of vitamins in food or a violation of their absorption. Hypovitaminosis is a disease that occurs when the body’s needs for vitamins are not fully met. In order to prevent vitamin deficiency, you need to know the causes of its development.

Primary (exogenous) hypovitaminosis may be due to a low content of vitamins in food, with monotonous and insufficient nutrition. Secondary (endogenous) vitamin deficiency occurs in diseases of the gastrointestinal tract, liver, endocrine disorders.

Hypovitaminosis A is accompanied by dryness of the oral mucosa, a tendency to hyperkeratosis, atrophic phenomena, erosion and manifestation, and the protective properties of the oral mucosa are reduced. There is a violation of the activity of the sebaceous glands, salivation decreases.

Hypovitaminosis B1 (thiamine) is accompanied by hyperplasia of the papillae of the tongue. There are functional disorders of the nervous system: paresthesia, neurosis, poor sleep, weakness. Allergic reactions of the oral mucosa may occur. The activity of the cardiovascular system and gastrointestinal tract is disturbed (nausea, vomiting, loss of appetite).

For treatment, drugs of thiamine chloride, bromide in tablets, solutions in ampoules are used. Special local treatment is not required.

Hypovitaminosis B2 (riboflavin) manifests itself as a triad: dermatitis, cheilitis, glossitis. Dermatitis occurs in the area of ​​the nasolabial folds, wings of the nose, eyelids in the form of redness, peeling, cracks and crusts in the corners of the mouth, angular stomatitis develops. In the future, the crusts are rejected, erosion occurs in their place. A pronounced violation is noted on the red border of the lips: multiple painful, bleeding cracks appear on it.

Changes in the tongue begin with hyperemia, then the papillae gradually atrophy, and the back of the tongue becomes bright red, smooth, shiny and dry. Changes on the lips are accompanied by burning and pain, especially when talking and eating. To clarify the diagnosis, biochemical studies of urine and blood are used.

Hypovitaminosis C – develops scurvy (scurvy, Meller-Barlow disease). In the occurrence of the disease, along with a lack of ascorbic acid in food, a number of factors play an important role: excessive physical activity, infectious diseases, hypothermia, tension of the nervous system, and the state of the gastrointestinal tract.

Accompanied by malaise, weakness, fatigue, lack of appetite, weight loss, pain in the calf muscles. The skin becomes dark, dry, easily flaky. In the oral cavity, hypovitaminosis is manifested by edema, cyanosis, increased bleeding of the gum mucosa, hemorrhagic diathesis, ulcerative necrotic processes. There are loosening of the gums, bleeding, accompanied by gingivitis. Mobility and loss of teeth are noted. In the oral cavity – severe hemorrhagic gingivitis.

Hypovitaminosis B12 and B9. Malignant megaloblastic anemia of Addison-Birmer develops. Peripheral nerve lesions (neuritis, neuralgia, paresthesia of the tongue and oral mucosa) are characteristic. An early sign is the defeat of the tongue: burning, tingling, paresthesia, hyperemia of the tip and lateral surfaces of the tongue is possible against the background of atrophy of its papillae – a “polished” tongue (Gunter’s glossitis, Meller-Gunter’s glossitis).

Treatment of hypovitaminosis

It provides for the introduction of missing vitamins into the body. The most physiological introduction of vitamins into the body is in the composition of food products. This is due to the fact that the products contain a number of substances that enhance the effect of vitamins and contribute to their better absorption. In addition, the consumption of vitamins with food is more physiological, since at the same time they are present with other nutrients, in the transformation of which vitamins are actively involved.

In order to avoid vitamin deficiency, you need to eat a variety of foods. Depending on the severity of vitamin deficiency, vitamin preparations are prescribed (preferably inside, but the doctor may also prescribe injections). Self-medication is dangerous, you need to consult a doctor.

Seizures in the corners of the lips in a child: causes, treatment, prevention of childhood cheilitis

Have you noticed sores with inflammation on the surfaces of the lips and in the corners of the child’s mouth? Are they wet at first, then crusty? These are snacks. Their appearance in the corners of the mouth provokes a bacterial or fungal infection against the background of a weakened immune system.

What are seizures

Scientifically they are called “cheilitis” (and also angulitis, angular cheilitis, angular stomatitis or slit-like impetigo).

These are mucosal lesions on the lips or micro-ulcers at the corners of the mouth. They most commonly occur in children aged 6–8 years, adolescents 13–16 years of age, and older people due to reduced immunity or other health problems. In children, seizures do not occur so often. But if the wounds are not treated, they will take a long time – several months.
Sores at the corners of the mouth may look like herpes, but more often they appear on the side of the mouth on one or both sides. Seizures are a bacterial disease, not an infectious disease. They are not contagious and are not transmitted by contact. Microulcers are striking, so they disturb not only the child, but also the mother. To treat a disease, you must first correctly diagnose it, then identify the cause and draw up a treatment plan.
A pediatrician at a routine examination immediately determines the nature of the sores on the lips – these are seizures, herpes, or just an injury. Cracks zayed usually occur first on the lips, then move to the skin at the corner of the mouth.

Depending on the source of occurrence, seizures are:

• fungal – appear as a result of Candida infection;
• bacterial – associated with the microbe staphylococcus aureus;
• mixed fungal-bacterial.

In an acute condition, the disease occurs quickly and responds well to treatment, it is considered a dermatological defect. In chronic seizures, the disease proceeds for a long time, deep cracks form in the corners of the lips, and relapses often occur after treatment.

How do seizures manifest in a child?

The external manifestation of cheilitis begins with the formation of small blisters on the mucous membrane of the lips, like herpes. Then the bubbles burst and the mucosa, together with the skin of the corners of the mouth, begins to peel off, crack, inflammation occurs.
The injured area is painful, the child feels discomfort if the mouth is opened wide or the lips are actively moved. The affected area is constantly wet, dries up and cracks again, bleeds. Erosion on the skin becomes a focus of inflammation. The child is in pain, there is a burning sensation, itching. The kid constantly puts his hands in his mouth and wants to scratch the pick-up, and this can cause an infection.

Causes of sticking in the corners of the mouth

Sticking can appear on the lips of a child for various reasons. Most often, seizures appear in children due to reduced immunity. If the child is healthy, staph or Candida on the skin is not a problem. As soon as the body’s defenses are reduced, these microbes are activated in places of damaged skin and provoke inflammation.

Common causes of seizure:

• candidiasis and staphylococcal bacilli;
• seasonal beriberi;
• allergy;
• worms;
• dental problems – malocclusion, caries, excessive salivation;
• failure in the digestive system – if you eat a lot of salty and sour foods;
• reduced immunity as a result of frequent SARS, tonsillitis;
• thyroid problems;
• reaction to certain medications, chemotherapy;
• blood diseases.

Quite often the cause of seizures in children lies in the lack of vitamins in the diet, especially in group B, riboflavin, iron and zinc. The reverse situation also occurs – an excess of vitamin A leads to cracks and complications.
If there is inflammation in the corners of the lips, be sure to keep them clean. The child can put dirty toys, nipples, pacifiers into his mouth, comb wounds. This aggravates the disease and leads to infection. With reduced immunity and frequent SARS, constant use of pacifiers, thumb sucking and frequent lip licking, the risk of jamming in a child is much higher.

Diagnosis of cheilitis

To determine the type and nature of the disease, the doctor examines the mouth and wounds on the skin and mucous membranes, vesicles, cracks, redness. Also, the specialist finds out from the parents the circumstances of the appearance of ulcers, possible causes of the disease, analyzes the history and the presence of chronic diseases.
Occasionally, a skin lesion at the corners of the mouth may indicate labial herpes or erosive lichen planus. To make an accurate diagnosis, the doctor takes a bacterial culture from the wound. It helps to identify the pathogen and choose the right medicine. You will be asked to take a blood, urine, feces test for worm eggs.

Treatment of seizures in children

Consultation with various specialists will help to determine more accurately than to treat seizures. The child should be seen not only by a pediatrician, but also by an infectious disease specialist, a gastroenterologist, a dermatologist, a dentist, an endocrinologist. After finding out the cause, the attending physician draws up a treatment plan.
Antibacterial and anti-inflammatory drugs, ointments, creams are prescribed. An infectious disease is treated with antibiotics, and antifungal agents are used for fungal infections.
In addition to the treatment of seizures with medicines, local care for cracks and wounds in the corners of the lips is important.