Eosinophilic Ulcer Treatment & Management

  • Author: Faizan Alawi, DDS; Chief Editor: William D James, MD   more...
 
Updated: Jan 18, 2012
 

Medical Care

  • Dental-related trauma
    • The source of chronic irritation must be eliminated when an eosinophilic ulcer is due to obvious trauma.
    • Referral to a dentist is recommended if the lesion is related to a tooth, dental restoration, or appliance.
    • Although extraction of the anterior primary teeth is not recommended, this may resolve the ulcerations in Riga-Fede disease. However, if the teeth are stable, they should be retained. In these cases, breastfeeding should be discontinued, or a protective shield should be constructed to prevent any further trauma. These measures are usually sufficient to resolve the condition.
  • Treatment modalities
    • Palliative care: Nonsteroidal anti-inflammatory drugs (NSAIDs) or topical anesthetics (eg, viscous lidocaine, benzocaine, dyclonine) may be used to provide temporary relief and comfort when the patient eats. A magic mouthwash may also provide symptomatic relief.
    • Therapeutic care: Some clinicians suggest that the use of corticosteroids may delay healing; however, a mixture of Orabase and a topical corticosteroid ointment (eg, clobetasol, fluocinonide, triamcinolone) is often effective. Dexamethasone elixir is also effective. Although unnecessary, systemic or intralesional corticosteroids may be used.
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Surgical Care

  • As a rule, if the lesion does not resolve or it continues to appear ominous after 2 weeks of treatment, biopsy is warranted.
  • After biopsy, rapid healing of the ulcer is often typical, even with large eosinophilic ulcers, and no further treatment is necessary.
  • Occasionally, lesions may have to be surgically excised.
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Consultations

  • Consultation with a dentist may be indicated to evaluate and repair fractured teeth or restorations or to alter dentures.
  • Consultation with an internist may be indicated for the evaluation of an underlying systemic condition in cases in which the ulcer persists, even after biopsy.
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Diet

Advise patients to maintain hydration and nourishment.

  • A soft diet is recommended for patients with painful ulcers and to avoid any further irritation.
  • Nutritional supplements, such as Ensure or Boost, may be necessary.
  • Advise patients to avoid eating acidic or spicy foods because they may cause additional discomfort.
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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  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 and American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, New York County Medical Society, New York Dermatological Society, Noah Worcester Dermatological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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

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.

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.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

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 and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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. 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. Apr 2011;33(2):192-4. [Medline].

  8. 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].

  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. Aug 2010;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. Jan-Feb 2007;56(1-2):73-9. [Medline].

  12. 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].

  13. 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].

  14. 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].

  15. 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].

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

  17. 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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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.
 
 
 
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