[Chronic graft-versus-host disease presenting as bullous lesions]. / Lesiones ampollosas como forma de presentación de una enfermedad de injerto contra huésped crónica.

Graft-vs-host disease is still the leading cause of morbidity and mortality in patients undergoing bone marrow transplantation. It is important to start treatment early to reduce the severity and consequences of this complication. Cutaneous lesions are often the presenting compliant of graft-vs-host disease and presage visceral involvement. We present the case of a 45-year-old woman with multiple myeloma who underwent autologous and subsequently allogeneic bone marrow transplantation with hematopoietic precursors. She developed bullous lesions with fluid elimination on the abdomen and legs. Biopsy findings were compatible with graft-vs-host disease and immunosuppressive therapy was increased. She subsequently presented oral lichenoid lesions and sicca syndrome. The bullous lesions progressed to painful ulcers that healed leaving highly sclerodermatous skin with substantial hyperpigmentation. Bullous lesions are a rare form of presentation of chronic graft-vs-host disease. In such cases, the diagnosis may not be suspected initially, particularly when the lesions are isolated and internal organs are not involved.

Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations.

Several therapeutic agents have been investigated for the treatment of oral lichen planus (OLP). Among these are corticosteroids, retinoids, cyclosporine, and phototherapy, in addition to other treatment modalities. A systematic review of clinical trials showed that particularly topical corticosteroids are often effective in the management of symptomatic OLP lichen planus. Systemic corticosteroids should be only considered for severe widespread OLP and for lichen planus involving other mucocutaneous sites. Because of the ongoing controversy in the literature about the possible premalignant character of OLP, periodic follow-up is recommended. There is a spectrum of oral lichen planus-like ("lichenoid") lesions that may confuse the differential diagnosis. These include lichenoid contact lesions, lichenoid drug reactions and lichenoid lesions of graft-versus-host disease. In regard to the approach to oral lichenoid contact lesions the value of patch testing remains controversial. Confirmation of the diagnosis of an oral lichenoid drug reaction may be difficult, since empiric withdrawal of the suspected drug and/or its substitution by an alternative agent may be complicated. Oral lichenoid lesions of graft-versus-host disease (OLL-GVHD) are recognized to have an association with malignancy. Local therapy for these lesions rests in topical agents, predominantly corticosteroids.

Líquen plano: a importância dos exames complementares para o seu diagnóstico e tratamento / Liquen plan: the importance of complementary exames for its diagnosis and treatment

O líquen plano é uma doença que se apresenta na forma de placa branca mucocutânea que ocorre usualmente após os 30 anos de idade e com uma maior freqüência em mucosa jugal. Sua etiologia é desconhecida, sendo ainda associadas a inúmeros fatores desencadeantes. É caracterizada por pequenas pápulas angulares planas, medindo poucos milímetros, podendo estar isoladas ou coalescer gradualmente em placas maiores, cobertas por finas escamas brilhantes. Muitas vezes o desaparecimento coincide com a melhora do estado emocional do paciente e o uso de corticóides

White lesions of the oral mucosa

A simple definition of a mucosal white lesion would be "a lesion which appears clinically whiter than the surrounding mucosa." Mucosal white lesions are to be taken seriously because a small proportion of these are known to possess malignant potential which often pose a diagnostic challenge even to an experienced clinician. Differentiation between white lesions with a potential is therefore of paramount importance. When in doubt, the clinician should always perform a biopsy of the lesion and seek a histopathologic report (AU)

Oral mucosal lesions associated with betel quid, areca nut and tobacco chewing habits: consensus from a workshop held in Kuala Lumpur, Malaysia, November 25-27, 1996.

A variety of betel/areca nut/tobacco habits have been reviewed and categorized because of their possible causal association with oral cancer and various oral precancerous lesions and conditions, and on account of their widespread occurrence in different parts of the world. At a recent workshop in Kuala Lumpur it was recommended that "quid" be defined as "a substance, or mixture of substances, placed in the mouth or chewed and remaining in contact with the mucosa, usually containing one or both of the two basic ingredients, tobacco and/or areca nut, in raw or any manufactured or processed form." Clear delineations on contents of the quid (areca nut quid, tobacco quid, and tobacco and areca nut quid) are recommended as absolute criteria with finer subdivisions to be added if necessary. The betel quid refers to any quid wrapped in betel leaf and is therefore a specific variety of quid. The workshop proposed that quid-related lesions should be categorized conceptually into two categories: first, those that are diffusely outlined and second, those localized at the site where a quid is regularly placed. Additional or expanded criteria and guidelines were proposed to define, describe or identify lesions such as chewer's mucosa, areca nut chewer's lesion, oral submucous fibrosis and other quid-related lesions. A new clinical entity, betel-quid lichenoid lesion, was also proposed to describe an oral lichen planus-like lesion associated with the betel quid habit.

Betel chewer's mucosa in elderly Cambodian women.

A total of 102 rural Cambodian women with a mean age of 60 +/- 8.5 years (range 39 to 80 years) who chewed betel quid were examined for oral mucosal lesions, in particular betel chewer's mucosa. The average duration of betel quid chewing was 15.5 +/- 12.8 years. The average number of daily betel quids was 5.4 +/- 2.9. Forty women (39.2%) used betel quids overnight. Thirty-eight (37.3%) did not show any oral mucosal lesion. Sixty-two (60.8%) showed betel chewer's mucosa. Homogeneous leukoplakia was found in three women (2.9%). Out of 130 sites affected by chewer's mucosa, the buccal mucosa was the most frequently involed (n = 68). In thirty-two subjects (31.4%) more than one location was affected. The presence of a lesion was significantly associated with the duration of the habit (P < 0.01) and the number of betel quids per day (P < 0.001). Betel chewing seems to be prevalent in elderly Cambodian women, while younger people do not seem to have taken up this habit. The risk for oral cancer in the Cambodian population is presently unknown.