eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Eosinophilic Ulcer: Follow-up

Author: Faizan Alawi, DDS, Assistant Professor, Department of Dermatology, Section of Dermatopathology, Hospital of the University of Pennsylvania
Coauthor(s): Paul D Freedman, DDS, Section Chief of Oral Pathology, Assistant Director, Assistant Professor of Surgery, Department of Dental Medicine, The New York Hospital, Cornell University Weill Medical College
Contributor Information and Disclosures

Updated: Oct 2, 2009

Follow-up

Further Outpatient Care

  • Once treatment is initiated, advise patients to return in 2 weeks for re-evaluation.
  • Biopsy is warranted if the lesion does not appear to be resolving with either topical steroid use or removal of the traumatic irritant.

Deterrence/Prevention

  • Patients should eliminate the source of the chronic irritation to prevent recurrence (see Causes).

Complications

  • If the ulcer does not resolve, even after biopsy and removal, the patient may have an underlying systemic condition that prevents the lesion from healing. The patient should be referred for a medical workup. Pilolli et al emphasize the importance of a differential diagnosis and a thorough evaluation.8
  • Clinicians should remember that deliberate self-mutilation may be a symptom of an underlying emotional disturbance. In cases of self-mutilation, patients may inflict injury to themselves to seek attention and sympathy or to obtain prescription medications. Psychiatric or psychological counseling is often necessary for these patients. Also see Malingering.

Prognosis

  • The prognosis is excellent, even with conservative treatment.
  • Recurrence is rare; however, the source of the chronic irritation should be eliminated to ensure that the ulcer does not recur.

Miscellaneous

Medicolegal Pitfalls

  • Occasionally, lesions may demonstrate atypical histologic features. These lesions have been misdiagnosed as lymphoma and unnecessary radical treatment can result.
  • Conversely, CD30-positive anaplastic lymphomas have been misdiagnosed as eosinophilic ulcers; therefore, immunohistochemical studies may be needed to confirm the diagnosis.7
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.



More on Eosinophilic Ulcer

Overview: Eosinophilic Ulcer
Differential Diagnoses & Workup: Eosinophilic Ulcer
Treatment & Medication: Eosinophilic Ulcer
Follow-up: Eosinophilic Ulcer
Multimedia: Eosinophilic Ulcer
References
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References

  1. Segura S, Pujol RM. Eosinophilic ulcer of the oral mucosa: a distinct entity or a non-specific reactive pattern?. Oral Dis. May 2008;14(4):287-95. [Medline].

  2. Elzay RP. Traumatic ulcerative granuloma with stromal eosinophilia (Riga-Fede's disease and traumatic eosinophilic granuloma). Oral Surg Oral Med Oral Pathol. May 1983;55(5):497-506. [Medline].

  3. Bhaskar SN, Lilly GE. Traumatic granuloma of the tongue (human and experimental). Oral Surg Oral Med Oral Pathol. Aug 1964;18:206-18. [Medline].

  4. Elovic AE, Gallagher GT, Kabani S, Galli SJ, Weller PF, Wong DT. Lack of TGF-alpha and TGF-beta 1 synthesis by human eosinophils in chronic oral ulcers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jun 1996;81(6):672-81. [Medline].

  5. Gerbig AW, Zala L, Hunziker T. Tumorlike eosinophilic granuloma of the skin. Am J Dermatopathol. Feb 2000;22(1):75-8. [Medline].

  6. Chawla O, Burke GA, MacBean AD. The eosinophilic ulcer revisited. Dent Update. Jan-Feb 2007;34(1):56-7. [Medline].

  7. Rosenberg A, Biesma DH, Sie-Go DM, Slootweg PJ. Primary extranodal CD3O-positive T-cell non-Hodgkins lymphoma of the oral mucosa. Report of two cases. Int J Oral Maxillofac Surg. Feb 1996;25(1):57-9. [Medline].

  8. Pilolli GP, Lucchese A, Scivetti M, Maiorano E, Favia G. Traumatic ulcerative granuloma with stromal eosinophilia of the oral mucosa: histological and immunohistochemical analysis of three cases. Minerva Stomatol. Jan-Feb 2007;56(1-2):73-9. [Medline].

  9. el-Mofty SK, Swanson PE, Wick MR, Miller AS. Eosinophilic ulcer of the oral mucosa. Report of 38 new cases with immunohistochemical observations. Oral Surg Oral Med Oral Pathol. Jun 1993;75(6):716-22. [Medline].

  10. Gopalakrishman R, Miloro M, Allen CM. Indurated ulceration of the tongue. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Aug 1996;82(2):119-21. [Medline].

  11. Mezei MM, Tron VA, Stewart WD, Rivers JK. Eosinophilic ulcer of the oral mucosa. J Am Acad Dermatol. Nov 1995;33(5 Pt 1):734-40. [Medline].

  12. Movassaghi K, Goodman ML, Keith D. Ulcerative eosinophilic granuloma: a report of five new cases. Br J Oral Maxillofac Surg. Feb 1996;34(1):115-7. [Medline].

  13. Neville BW, Damm DD, Allen CM. Oral and Maxillofacial Pathology. ed. Philadelphia, Pa: WB Saunders; 1995:213-22.

  14. Regezi JA, Zarbo RJ, Daniels TE, Greenspan JS. Oral traumatic granuloma. Characterization of the cellular infiltrate. Oral Surg Oral Med Oral Pathol. Jun 1993;75(6):723-7. [Medline].

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Further Reading

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Keywords

eosinophilic ulcer, oral eosinophilic ulcer, oral ulcer, oral mucosa ulcer, traumatic ulcerative granuloma with stromal eosinophilia, TUGSE, traumatic granuloma, Riga-Fede disease in infants, ulcerated granuloma eosinophilicum diutinum, eosinophilic granuloma of soft tissue, EU, oral ulcer

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Contributor Information and Disclosures

Author

Faizan Alawi, DDS, Assistant Professor, Department of Dermatology, Section of Dermatopathology, Hospital of the University of Pennsylvania
Faizan Alawi, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology
Disclosure: Nothing to disclose.

Coauthor(s)

Paul D Freedman, DDS, Section Chief of Oral Pathology, Assistant Director, Assistant Professor of Surgery, Department of Dental Medicine, The New York Hospital, Cornell University Weill Medical College
Paul D Freedman, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology and American Dental Association
Disclosure: Nothing to disclose.

Medical Editor

Donald Belsito, MD, Clinical Professor, Department of Internal Medicine, Division of Dermatology, University of Missouri at Kansas City; Private Practice, American Dermatology Associates, LLC
Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, Kansas Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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