Subcutaneous granuloma annulare

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Erosive lesions of the oral mucosa: a diagnostic approach based on clinical cases

Erosive and ulcerative lesions of the oral mucosa reperesent a major problem in dermatological practice; a new diagnostic approach helps to prevent misdiagnosis and improves the treatment.Leziunile eroziv-ulcerative ale mucoasei orale constituie o problemă comună şi complexă din punctul de vedere al diagnosticului, aspectul clinic fiind adesea nespecific. Ele pot fi datorate unor cauze variate, de la simple traumatisme (fizice, mecanice, chimice), la stomatite infecţioase sau maladii sistemice autoimune, până la procese proliferative maligne. Orientarea diagnostică se sprijină pe investigaţii paraclinice ţintite în funcţie de natura patogenică a condiţiei suspicionate. Pornind de la datele anamnezice şi aspectul clinic, se poate elabora un arbore decizional al etapelor de evaluare pentru diagnosticul de certitudine. Astfel, în funcţie de evoluţie şi aspectul clinic, leziunile eroziv-ulcerative orale se pot clasifica în acute solitare (posttraumatice), acute multiple (de exemplu gingivo-stomatita herpetică), cronice solitare (de exemplu carcinomul scuamocelular oral) şi cronice multiple (de exemplu pemfigusul vulgar). Exemplificăm patologia eroziv-ulcerativă a mucoasei orale cu câteva cazuri afl ate în evidenţa Clinicii Dermatologice a Spitalului Clinic Universitar C.F. Iaşi. Importanţa încadrării nosologice corecte a unei stomatite eroziv-ulcerative rezidă în evitarea erorilor de diagnostic, care întârzie tratamentul corect al unor condiţii morbide cu impact sever

THE IMPORTANCE OF DUAL DERMATOLOGIC AND PSYCHIATRIC APPROACH IN PSYCHOCUTANEOUS DISORDERS

Psychodermatology or psychocutaneous medicine is a relatively old domain, built on well studied and documented connections between mental / psychic and skin. Numerous studies highlight the idea that evolution of a significant percentage of dermatoses is negatively influenced by psychological factors and stress and that mental state affects not only how the disease is perceived but its severity as well. It is estimated that 30-40% of dermatological patients show a concurrent mental disorder or psychological problems that may be the causative, predisposing or aggravating factor of the cutaneous disease. Morbid conditions such as psoriasis, atopic dermatitis, alopecia areata, vitiligo, severe acne have a marked negative impact on patient quality of life through both debilitating and chronic character of the diseases and by their psychosocial consequences: decreased self-esteem, embarrassment, depression, social phobia, social discrimination to employment, family and couple relations alteration. Collaboration with a psychiatrist for optimal management of psihocutaneous disorders is essential but difficult to acheive because most patients with such morbidity refuse (do not accept) the referral to psychiatric/psychologic consultation. Therefore the dermatologists need to have knowledge on pharmacological and non-pharmacological means useful in treating these disorders and to reconsider the importance of training in the field of psihodermatology. Cutaneous side effects of psychotropic drugs must also be known because they are more frequently encountered than most common psychiatric side effects of drugs used in dermatology

Pyostomatitis Vegetans

Pyostomatitis vegetans is a rare oral disorder with unclear pathogenesis, that may be associated with inflammatory gastro-intestinal diseases, cutaneous involvement or with other disorders of the joints, eyes or liver. The etiology of the extraintestinal manifestations of inflammatory bowel diseases is obscure, but it is believed that the injured intestinal mucosa may trigger immune responses related to inflammatory processes in extraintestinal areas. Oral manifestations include amicrobial pustules and yellow ulcerations with a typical aspect of snail tracts on the bucal and labial mucosa and on the dorsum of the tongue. Histopathological exam shows epithelial acanthosis and superficial ulcerations, as well as eosinophilic and neutrophilic infiltrate in the subjacent connective tissue. Intraepithelial and subepithelial milliary abcesses may also be present. The available therapeutical alternatives (systemic and topical corticosteroids, sulphones, retinoids) have a relatively poor and transitory effect. We present the case of a teenage girl with oral lesions and histopathological features suggestive for pyostomatitis vegetans, persistent for approximately one year, with no other cutaneous or systemic involvement

NEW INSIGHTS INTO THE PATHOPHYSIOLOGY OF GEOGRAPHIC TONGUE

Geographic Tongue (GT), also known as benign migratory glossitis, is a benign inflammatory condition characterised by irregular, smooth, red patches on the tongue surface, often with a white or light-coloured border. Despite being a common oral condition, its pathophysiology remains poorly understood. This review aims to shed light on the latest insights into the pathophysiology of GT, exploring its etiological factors, immunological aspects, and potential genetic predispositions. We discuss the role of environmental factors, such as stress and dietary habits, and delve into the immunopathological mechanisms that may contribute to the manifestation of GT. The review also examines the possible genetic and epigenetic factors involved in GT and their interaction with environmental triggers. Recent advancements in molecular biology and genetics offer new perspectives in understanding the complex nature of GT, paving the way for improved diagnostic and therapeutic approaches. This review concludes with a discussion on the potential future directions in GT research, focusing on the need for larger epidemiological studies and the exploration of novel therapeutic targets

THE IMPACT OF GUT MICROBIOTA ON RECURRENT APHTHOUS STOMATITIS

Recurrent Aphthous Stomatitis (RAS) is a prevalent oral mucosal disorder characterized by recurring painful ulcers. The pathogenesis of RAS remains incompletely understood, but emerging evidence suggests a significant link between gut microbiota and the development of RAS. This review aims to explore the existing literature on the interplay between gut microbiota and RAS, focusing on how intestinal dysbiosis may influence the onset and severity of RAS. We discuss the role of gut microbiota in immune modulation, the breakdown of oral tolerance, and the possible pathways through which gut bacteria can affect oral health. Additionally, we examine the impact of diet, antibiotics, and probiotics on the gut microbiota and, subsequently, on RAS. The review concludes with potential therapeutic strategies targeting gut microbiota to manage and prevent RAS, paving the way for novel interventions in this field

DERMATOSCOPIC INSIGHTS INTO THE MOST COMMON POTENTIALLY MALIGNANT ORAL LESIONS

The early detection and accurate diagnosis of potentially malignant oral lesions, such as actinic cheilitis, leukoplakia, and oral lichen planus, are crucial for improving patient outcomes. Dermatoscopy, a non-invasive diagnostic technique, offers enhanced visualisation of these lesions, enabling precise assessment of morphological features critical for early recognition and differential diagnosis. This article aims to present dermatoscopic findings from cases of these common conditions, highlighting their importance in refining clinical management. Dermatoscopy not only improves diagnostic accuracy by revealing detailed lesion characteristics but also assists in evaluating malignancy risk, monitoring progression, and guiding the decision-making process for biopsy and treatment. While biopsy remains definitive for diagnosis, dermatoscopy serves as a valuable preliminary tool. Future research should focus on establishing standardised dermatoscopic criteria for oral lesions and integrating dermatoscopy into regular oral health evaluations to advance patient care

PYOSTOMATITIS VEGETANS

Pyostomatitis vegetans is a rare oral disorder with not clear pathogeny, which can be associated with inflammatory gastro-intestinal diseases, cutaneous manifestations or other disorders at articular, hepatic or ocular level. The oral condition is manifested through amicrobian pustule and yellow ulcerations having the „snail tracts” aspect on the jugal and labial mucosa and the tongues dorsal side. The histopathologic analysis reveals epithelial acantosis and superficial ulcerations, as well as neutrophilic and eosinophilic infiltrate into the subiacent conjunctive tissue. The available therapies (systemic and topic corticosteroids) have a relative and transitory benefit. We present the case of a female teenager with oral lesions and histopathologic modifications at their level significant for pyostomatitis vegetans, 1 year old, without other cutaneous or systemic change

THE IMPACT OF SYSTEMIC CORTICOSTEROID THERAPY ON ORAL HEALTH: COMPLICATIONS AND MANAGEMENT STRATEGIES

Corticosteroids, including glucocorticoids, mineralocorticoids, and androgenic hormones, are hormonal mediators produced by the adrenal glands and are widely used in the treatment of various conditions, including dental diseases. While systemic corticosteroid therapy offers significant therapeutic benefits, it is crucial to understand the potential adverse effects on oral health. This paper aims to highlight the impact of systemic corticosteroid therapy on oral health, focusing particularly on the associated complications and management strategies. The paper emphasizes specific complications that may occur in the oral cavity as a result of corticosteroid use, the most important being an increased susceptibility to oral infections such as candidiasis and impaired bone metabolism, with a significant reduction in the mineral density of the mandibular bone (BMD), as well as delayed wound healing, the occurrence of oral ulcers, and changes in the oral microbiome. Furthermore, the importance of rigorous oral care and regular dental monitoring for patients undergoing systemic corticosteroid therapy is underlined. The role of oral health specialists in the early detection and efficient management of oral complications, as well as patient education regarding proper oral hygiene practices and possible side effects, is of crucial importance. In conclusion, it is essential for healthcare providers to be vigilant regarding the potential oral health complications associated with systemic corticosteroid therapy, and early detection, prevention, and the implementation of appropriate management strategies are fundamental for optimizing oral health outcomes in patients undergoing corticosteroid treatment