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Lichen planus
Median
rhomboid
glossitis
tory cascade specically acting against interleukin-3. These symptoms occur, they typically include the sudden onset
are applied to the ulcer two to four times daily until healing of 1- to 2-mm vesicles bordered by an inammatory, ery-
occurs. Topical corticosteroids are also used in treatment. thematous base associated with fever. These lesions rupture
When applied directly to the dried ulcer or area of pro- to form ulcers. Primary oral HSV lesions tend to involve
dromal pain and paresthesia, they reduce the duration of the buccal mucosa. Recurrent disease is usually conned
the lesion, but they do not affect the frequency of recur- to keratinized areas, like the lips or perioral areas. The
rence. Intralesional steroid injections and systemic corti- ulcers undergo spontaneous healing in 10 to 14 days.
costeroids are reserved for more persistent cases of major Recurrent oral herpes is not associated with fever and may
RAUs. Thalidomide has been shown to decrease lesion be incited by exposure to sunlight, trauma, and emotional
duration and disease-free time in refractory RAUs. However, stress. Most patients develop pain, burning, and tingling
this treatment has severe side effectsteratogenicity and about 24 hours before the appearance of recurrent lesions.
peripheral neuropathywhich have limited its use. The differential diagnosis of these lesions is similar to that
of aphthous ulcers. The diagnosis is generally clinical but
may be conrmed by identifying multinucleated giant cells
Infectious Lesions
on a Tzanck smear. Viral culture from lesions is the gold
Viral Stomatitis standard for diagnosis.
Herpes Simplex
OPTIMUM TREATMENT. Most immunocompetent indi-
Herpes simplex is the most common organism causing viral viduals with recurrent herpes labialis do not require treat-
stomatitis. Initial exposure to herpes simplex virus (HSV) ment other than the occasional use of local analgesics.
usually occurs during childhood. After resolution of the Steroid treatment is contraindicated. Systemic acyclovir
initial infection, the virus remains latent in the trigeminal may shorten episodes and increase disease-free intervals
ganglion. Primary infection is often asymptomatic. When but works when the virus is most active, which is usually
11 Common Oral Lesions 65
Torus palatinus
Mucocele of lip
Papillomas of soft palate and anterior pillar
Hairy tongue