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Eosinophilic Ulcer Treatment & Management

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

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.

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 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.

 
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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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