Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Eosinophilic Ulcer Medication

  • Author: Faizan Alawi, DDS; Chief Editor: William D James, MD  more...
 
Updated: Sep 22, 2014
 

Medication Summary

NSAIDs or topical anesthetics (eg, viscous lidocaine, benzocaine, dyclonine) may be used to provide temporary pain relief and comfort while the patient eats.

Some clinicians suggest that the use of corticosteroids may delay healing; however, a mixture Orabase with a topical corticosteroid ointment (eg, clobetasol, fluocinonide, triamcinolone) often is effective.

Although unnecessary, treatment with systemic prednisone or intralesional injections of triamcinolone has been successful in some patients.

Dexamethasone elixir and magic mouthwash may also provide relief.

Next

Topical anesthetics

Class Summary

These agents may provide temporary symptomatic relief of pain. They also may improve the patient's comfort while eating.

Viscous lidocaine 2% (Xylocaine)

 

Anesthetic liquid prescribed to treat painful lesions of the oral mucosa or lips. Inhibits neuronal membrane depolarization, blocking nerve impulses.

For small lesions, apply to ulcer with a cotton-tipped applicator. Generally not recommended for use in children because therapeutic doses usually approach potentially toxic levels. If necessary, use lowest effective dose and supervise children.

Benzocaine (Americaine, Benzocol, Cylex)

 

Inhibits neuronal membrane depolarization, blocking nerve impulses. In pediatric patients, this is a safe alternative to lidocaine.

Dyclonine (Dyclone)

 

Ketone local anesthetic agent administered topically. Affects cell membrane permeability and blocks impulses at peripheral nerve endings in mucosa.

Previous
Next

Analgesics

Class Summary

Analgesics are used for the relief of mild to moderate pain.

Ibuprofen (Motrin, Advil, Pediaprofen)

 

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Acetaminophen (Tylenol, Tempra, FeverAll, Aspirin-Free Anacin)

 

DOC for pain relief in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper GI tract disease, or those who are taking oral anticoagulants.

Previous
Next

Dental aids and preparations

Class Summary

These are topical corticosteroids that share anti-inflammatory, antipruritic, and vasoconstrictive properties. However, they should be mixed with a carrier such as Orabase to ensure adherence of the drug to the mucosal surface. Otherwise, saliva quickly washes away the medication.

Clobetasol (Temovate in Orabase)

 

Class I superpotent topical steroid; suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction. Ointment is recommended for intraoral use. Most pharmacists mix 15 g of clobetasol with 15 g of Orabase; this should be indicated on the prescription.

Fluocinonide (Lidex in Orabase)

 

Class II high-potency topical corticosteroid that inhibits cell proliferation; immunosuppressive and anti-inflammatory. Ointment is recommended for intraoral use. Most pharmacists mix 15 g of fluocinonide with 15 g of Orabase; this should be indicated on the prescription.

Triamcinolone topical (Kenalog in Orabase)

 

Group III, intermediate potency. Used to treat inflammatory mucosal lesions that are responsive to steroids. Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. Ointment is recommended for intraoral use. Most pharmacists mix 15 g of triamcinolone with 15 g of Orabase; this should be indicated on the prescription.

Previous
Next

Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

Dexamethasone (Decadron, Dexone, Hexadrol, Methasone)

 

Elixir for various allergic and inflammatory diseases. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Supervise pediatric patients during administration.

Prednisone (Orasone, Deltasone, Meticorten)

 

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. In most cases, systemic corticosteroids are unnecessary in the management of eosinophilic ulcers. Dividing dose may increase efficacy, but also increase risk of adrenal suppression/adverse effects.

Previous
Next

Palliative agents

Class Summary

These agents provide temporary symptomatic relief and may improve the patient's comfort while eating.

Diphenhydramine, aluminum hydroxide, magnesium carbonate (Magic Mouthwash)

 

Provides symptomatic relief of stomatitis. Variations of this formulation may be available through a pharmacy or may be personally specified.

Standard recipe may include 30 mL diphenhydramine (Benadryl) elixir, 60 mL calcium carbonate and magnesium hydroxide (Mylanta), and 4 g sucralfate (Carafate). Preparations may also include tetracycline (avoid tetracycline if < 9 y), attapulgite (Kaopectate), lidocaine, cherry syrup (for children), or hydrocortisone.

Previous
 
 
Contributor Information and Disclosures
Author

Faizan Alawi, DDS Associate Professor, Department of Pathology, Penn Dental Medicine, University of Pennsylvania School of Dental Medicine; Associate 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, International Association for Dental Research

Disclosure: Nothing to disclose.

Coauthor(s)

Paul D Freedman, DDS Director of Oral Pathology, New York Hospital Medical Center of Queens; Chief, Division of Oral Pathology and Oral Medicine, New York Presbyterian Hospital; Associate Professor of Surgery, Weill Cornell Medical College

Paul D Freedman, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

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, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Donald Belsito, MD Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: New York County Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, American Contact Dermatitis Society, Dermatology Foundation, Dermatologic Society of Greater New York, Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

References
  1. Segura S, Pujol RM. Eosinophilic ulcer of the oral mucosa: a distinct entity or a non-specific reactive pattern?. Oral Dis. 2008 May. 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. 1983 May. 55(5):497-506. [Medline].

  3. Bhaskar SN, Lilly GE. Traumatic granuloma of the tongue (human and experimental). Oral Surg Oral Med Oral Pathol. 1964 Aug. 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. 1996 Jun. 81(6):672-81. [Medline].

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

  6. Chawla O, Burke GA, MacBean AD. The eosinophilic ulcer revisited. Dent Update. 2007 Jan-Feb. 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. 1996 Feb. 25(1):57-9. [Medline].

  8. Eleni G, Panagiotis S, Andreas K, Georgia A. Traumatic ulcerative granuloma with stromal eosinophilia: a lesion with alarming histopathologic presentation and benign clinical course. Am J Dermatopathol. 2011 Apr. 33(2):192-4. [Medline].

  9. Abdel-Naser MB, Tsatsou F, Hippe S, Knolle J, Anagnostopoulos I, Stein H, et al. Oral eosinophilic ulcer, an Epstein-Barr virus-associated CD30+ lymphoproliferation?. Dermatology. 2011. 222(2):113-8. [Medline].

  10. Misterska M, Dmochowski M, Szulczynska-Gabor J, Walkowiak H, Bowszyc-Dmochowska M, Kaczmarek J, et al. Eosinophilic ulcer of the oral mucosa: report of a child with CD30-negative cells in an infiltration on the lower lip. Med Sci Monit. 2010 Aug. 16(8):CS95-9. [Medline].

  11. 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. 2007 Jan-Feb. 56(1-2):73-9. [Medline].

  12. Neville BW, Damm DD, Allen CM. Oral and Maxillofacial Pathology. 1st ed. Philadelphia, Pa: WB Saunders; 1995. 213-22.

Previous
Next
 
A 47-year-old African American woman with an eosinophilic ulcer on the lateral surface of the tongue. The anterior border of the lesion is raised. Courtesy of Dr Paul D. Freedman.
Raised, indurated, nonhealing ulcer on the lateral surface of the tongue. The lesion was related to an adjacent fractured tooth. Courtesy of Dr Paul D. Freedman.
Ulcer on the ventrolateral surface of the tongue. The differential diagnosis should include squamous cell carcinoma or an infectious etiology. Courtesy of Dr Paul D. Freedman.
Lesion on the lateral surface of the tongue. Courtesy of Dr Paul D. Freedman.
Low-power view showing an ulcerated surface epithelium with a dense cellular inflammatory infiltrate underlying the mucosal surface (original magnification X40). Courtesy of Dr Paul D. Freedman.
Cellular infiltrate composed mainly of large mononuclear cells, including histiocytes and submucosal dendrocytes, eosinophils, and scattered T lymphocytes (original magnification X400). Courtesy of Dr Paul D. Freedman.
Inflammatory infiltrate extending through and between muscle bundles (original magnification X400). Courtesy of Dr Paul D. Freedman.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.