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Chellapandian N, Boopathi D. Oral vitiligo: a predominant spread from oral mucosa. BMJ Case Rep 2023; 16:e257609. [PMID: 37821146 PMCID: PMC10583097 DOI: 10.1136/bcr-2023-257609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Depigmented lesions of the oral cavity have been rarely reported. Vitiligo has been defined as an acquired, slowly progressive loss of cutaneous pigment which occurs as irregular, sharply defined patches which may or may not be surrounded by macroscopic hyperpigmentation. Though vitiligo is a common condition affecting the skin having global a prevalence of 0.5%-2% the same affecting the oral mucosal tissue is a rare scenario. Literature review yields only a dearth of cases of oral vitiligo until now. Here we report a case of oral vitiligo involving the entire oral mucosal tissues with anaemic stomatitis. This case is unique as it had entire oral mucosal involvement and the skin involvement being minimal.
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Affiliation(s)
- Naveenaa Chellapandian
- Department of Oral Medicine and Radiology, Indira Gandhi Institute of Dental Sciences, Pondicherry, India
| | - Durgadevi Boopathi
- Oral Medicine and Maxillofacial Radiology, Indira Gandhi Institute of Dental Sciences, Pondicherry, India
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Bugălă NM, Carsote M, Stoica LE, Albulescu DM, Ţuculină MJ, Preda SA, Boicea AR, Alexandru DO. New Approach to Addison Disease: Oral Manifestations Due to Endocrine Dysfunction and Comorbidity Burden. Diagnostics (Basel) 2022; 12:diagnostics12092080. [PMID: 36140482 PMCID: PMC9497746 DOI: 10.3390/diagnostics12092080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
This review highlights oral anomalies with major clinical impact in Addison disease (AD), including dental health and dermatologic features, through a dual perspective: pigmentation issues and AD comorbidities with oral manifestations. Affecting 92% of AD patients, cutaneomucosal hyperpigmentation is synchronous with or precedes general manifestations by up to a decade, underlying melanocytic infiltration of the basal epidermal layer; melanophages in the superficial dermis; and, rarely, acanthosis, perivascular lymphocytic infiltrate, and hyperkeratosis. Intraoral pigmentation might be the only sign of AD; thus, early recognition is mandatory, and biopsy is helpful in selected cases. The buccal area is the most affected location; other sites are palatine arches, lips, gums, and tongue. Pigmented oral lesions are patchy or diffuse; mostly asymptomatic; and occasionally accompanied by pain, itchiness, and burn-like lesions. Pigmented lingual patches are isolated or multiple, located on dorsal and lateral areas; fungiform pigmented papillae are also reported in AD individuals. Dermoscopy examination is particularly indicated for fungal etiology; yet, it is not routinely performed. AD’s comorbidity burden includes the cluster of autoimmune polyglandular syndrome (APS) type 1 underlying AIRE gene malfunction. Chronic cutaneomucosal candidiasis (CMC), including oral CMC, represents the first sign of APS1 in 70–80% of cases, displaying autoantibodies against interleukin (IL)-17A, IL-17F ± IL-22, and probably a high mucosal concentration of interferon (IFN)-γ. CMC is prone to systemic candidiasis, representing a procarcinogenic status due to Th17 cell anomalies. In APS1, the first cause of mortality is infections (24%), followed by oral and esophageal cancers (15%). Autoimmune hypoparathyroidism (HyP) is the earliest endocrine element in APS1; a combination of CMC by the age of 5 years and dental enamel hypoplasia (the most frequent dental complication of pediatric HyP) by the age of 15 is an indication for HyP assessment. Children with HyP might experience short dental roots, enamel opacities, hypodontia, and eruption dysfunctions. Copresence of APS-related type 1 diabetes mellitus (DM) enhances the risk of CMC, as well as periodontal disease (PD). Anemia-related mucosal pallor is related to DM, hypothyroidism, hypogonadism, corresponding gastroenterological diseases (Crohn’s disease also presents oral ulceration (OU), mucogingivitis, and a 2–3 times higher risk of PD; Biermer anemia might cause hyperpigmentation by itself), and rheumatologic diseases (lupus induces OU, honeycomb plaques, keratotic plaques, angular cheilitis, buccal petechial lesions, and PD). In more than half of the patients, associated vitiligo involves depigmentation of oral mucosa at different levels (palatal, gingival, alveolar, buccal mucosa, and lips). Celiac disease may manifest xerostomia, dry lips, OU, sialadenitis, recurrent aphthous stomatitis and dental enamel defects in children, a higher prevalence of caries and dentin sensitivity, and gingival bleeding. Oral pigmented lesions might provide a useful index of suspicion for AD in apparently healthy individuals, and thus an adrenocorticotropic hormone (ACTH) stimulation is useful. The spectrum of autoimmune AD comorbidities massively complicates the overall picture of oral manifestations.
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Affiliation(s)
- Narcis Mihăiţă Bugălă
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- C.I. Parhon National Institute of Endocrinology, Aviatorilor Ave. 34–38, Sector 1, 011683 Bucharest, Romania
- Correspondence: ; Tel.: +40-744851934
| | - Loredana Elena Stoica
- Department of Dermatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dana Maria Albulescu
- Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Jana Ţuculină
- Department of Odontology, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Smaranda Adelina Preda
- Department of Odontology, Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ancuta-Ramona Boicea
- Department of Occupational Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dragoș Ovidiu Alexandru
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Leung AKC, Lam JM, Leong KF, Hon KL. Vitiligo: An Updated Narrative Review. Curr Pediatr Rev 2021; 17:76-91. [PMID: 33302860 DOI: 10.2174/1573396316666201210125858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism. OBJECTIVE This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo. METHODS A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English language. The information retrieved from the above search was used in the compilation of the present article. RESULTS Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment. CONCLUSION The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
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The relationship between stress and vitiligo: Evaluating perceived stress and electronic medical record data. PLoS One 2020; 15:e0227909. [PMID: 31986193 PMCID: PMC6984686 DOI: 10.1371/journal.pone.0227909] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
Vitiligo is a T-cell mediated skin disorder characterized by progressive loss of skin color. In individuals genetically predisposed to the disease, various triggers contribute to the initiation of vitiligo. Precipitating factors can stress the skin, leading to T-cell activation and recruitment. Though hereditary factors are implicated in the pathogenesis of vitiligo, it is unknown whether precipitating, stressful events play a role in vitiligo. To understand this, we utilized a validated perceived stress scale (PSS) to measure this parameter in vitiligo patients compared to persons without vitiligo. Additionally, we probed a clinical database, using a knowledge linking software called ROCKET, to gauge stress-related conditions in the vitiligo patient population. From a pool of patients in an existing database, a hundred individuals with vitiligo and twenty-five age- and sex-matched comparison group of individuals without vitiligo completed an online survey to quantify their levels of perceived stress. In parallel, patients described specifics of their disease condition, including the affected body sites, the extent, duration and activity of their vitiligo. Perceived stress was significantly higher among vitiligo individuals compared to those without vitiligo. ROCKET analyses suggested signs of metabolic-related disease (i.e., ‘stress’) preceding vitiligo development. No correlation was found between perceived stress and the stage or the extent of disease, suggesting that elevated stress may not be a consequence of pigment loss alone. The data provide further support for stress as a precipitating factor in vitiligo development.
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Robledo-Sierra J, Bäckman K, Öhman J, Jontell M. Oral lichen sclerosus: an overview and report of three cases. Int J Oral Maxillofac Surg 2018; 47:1550-1556. [DOI: 10.1016/j.ijom.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/16/2018] [Accepted: 04/08/2018] [Indexed: 01/15/2023]
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Fricain M, Weidmann P, Roche Y, Fricain JC. Labial vitiligo associated with a factice disorder: a case report. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2018010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction:
Vitiligo is a non-contagious leukoderma. The loss of melanocytes result in a local hypopigmentation like white symmetrical plaques with sharp edges, most of the time surrounded by hyperpigmentation. It might be an auto immune disease with a genetic predisposition linked to psychological disorders. Oral mucosa vitiligo has rarely been described in the literature. Observation: A seventeen years old patient, native from North Africa, has consulted for a half left upper lip depigmentation appeared in October 2016. The dermatologist had made the diagnosis of vitiligo and prescribed vitamin C and folic acid, without any result. In July 2017, as the lesion has extended to the whole upper lip, the patient came to oral mucosa pathology consultation. Anamnesis revealed a chronic lips chewing. Clinical examination revealed a linear vermillion border depigmentation of the upper lip associated with peripheral pigment enhancement, as well as digital cutaneous involvement. The prescribed treatment was: tacrolimus 0.1% twice daily in local application, stopping practice disorder and sun protection. Comment: Diagnosis of vitiligo is based on clinical examination that can differentiate a segmental vitiligo (localized on at least one dermatomes) of a non-segmental vitiligo (acrofacial, generalized, universalis). Vitiligo of the oral mucosa is rare. It has mainly been described in India. Oral mucosa involvement would affect 55% of patient and the lip would be affected in almost one in two cases in this population. Conclusion: Oral mucosa vitiligo must be known by oral surgeon who has to master the diagnosis and treatments in association with dermatologist, given the concomitant skin involvement that is almost mandatory.
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Chauhan A. Interplay of vitamin D with T regulatory cells (FOXP3+Treg) and thymic stromal lymphopoietin (TSLP) in children with atopic diseases. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/moji.2018.06.00201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Marangon Júnior H, Souza PEA, Soares RV, Gomez RS, Pereira GHDM, Horta MCR. Oral Lichen Sclerosus: A Rare Case Report and Review of the Literature. Head Neck Pathol 2016; 11:212-218. [PMID: 27807761 PMCID: PMC5429284 DOI: 10.1007/s12105-016-0766-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease that often affects the anogenital area and causes significant discomfort and morbidity. Oral mucosal lesions in LS are extremely rare and might be associated with genital and/or skin manifestations. As a unique manifestation of LS, oral lesions are even more rare, with only 20 cases reported in English-language literature. In reviewing that literature in this paper, we present the case of a 44-year-old white man who sought dental assistance with a complaint of a white spot on his upper lip. Extraoral clinical examination revealed a slight white macule on the left upper lip vermilion next to the labial commissure. Intraoral examination revealed that the macule was approximately 3.5 × 2.0 cm, extended to the upper left labial mucosa, and presented an ivory-white color. Following an incisional biopsy and microscopy, the lesion was shown to be covered by a stratified squamous epithelium showing hyperkeratosis and atrophy. The superficial lamina propria revealed a well-marked band of subepithelial hyalinization and, below it, a band-like mononuclear inflammatory infiltrate. Sections stained by Verhoeff's technique revealed a scantiness of elastic fibers in the superficial lamina propria. The diagnosis of LS was then established. The patient was referred for dermatologic evaluation, which identified no skin or genital lesions, and no treatment was employed. After 6 years, no significant changes in clinical features were observed. Altogether, this rare case makes an important contribution to knowledge on this uncommon condition.
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Affiliation(s)
- Helvécio Marangon Júnior
- 0000 0001 2155 6671grid.412520.0Oral Pathology Division, School of Dentistry, Pontifical Catholic University of Minas Gerais, Avenida Dom José Gaspar, 500, Prédio 46, Sala 101, Coração Eucarístico, Belo Horizonte, MG 30535-901 Brazil
| | - Paulo Eduardo Alencar Souza
- 0000 0001 2155 6671grid.412520.0Oral Pathology Division, School of Dentistry, Pontifical Catholic University of Minas Gerais, Avenida Dom José Gaspar, 500, Prédio 46, Sala 101, Coração Eucarístico, Belo Horizonte, MG 30535-901 Brazil
| | - Rodrigo Villamarim Soares
- 0000 0001 2155 6671grid.412520.0Periodontology Division, School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Ricardo Santiago Gomez
- 0000 0001 2181 4888grid.8430.fDepartment of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | | | - Martinho Campolina Rebello Horta
- 0000 0001 2155 6671grid.412520.0Oral Pathology Division, School of Dentistry, Pontifical Catholic University of Minas Gerais, Avenida Dom José Gaspar, 500, Prédio 46, Sala 101, Coração Eucarístico, Belo Horizonte, MG 30535-901 Brazil
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