Skin disorders in the Lips/Mouth

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Fordyce Glands

• These are very common skin lesions found in normal individuals.
• White spots are seen on the inner walls of the buccal cheeks and along the lips.
• They are aberrant oil glands (sebaceous) and are harmless.
• There is no specific treatment.

Fissured Tongue

• A Fissured tongue has prominent furrows on its surface.
• It can be seen in normal people but is also more common in individuals with a genetic condition called Down’s Syndrome.
• There is no specific treatment for this disorder and is best left alone.

Oral Candidiasis

• It is an infection caused by yeast.
• It is sometimes seen in children and also in adults with poor fitting dentures, taking broad-spectrum antibiotics or oral steroid or suffering from diabetes or from depressed immune system.
• White, creamy patches appear on the oral mucosa or tongue which will leave raw red spots when the white patches are scraped off.
• Treatment include oral hygiene, elemination of predisposing factors and the use of topical or/and oral antifungal agents.
• Patients should consult their doctors to be investigated. They should not self-medicate as an underlying disorder has to be excluded.

  

  Oral Candidiasis

Oral Leukoplakia

• Commonly seen in the elderly, it appears as white patches on the surface of the tongue or mucosa of the mouth or lips. The white patches cannot be easily wiped off.
• Smoking, tobacco chewing and chronic irritation eg. from poorly fitting dentures predispose to leukoplakia.
• The lesion may turn cancerous. Hence a biopsy and close follow-up are required.

Actinic Cheilitis

• It is the equivalent of actinic keratosis when it is located on the lips.
• The lesion can transform into skin cancer needs to be removed.

  

  Actinic Cheilitis

Cold Sores (Herpetic Gingivostomatitis)

1. The infection is caused by Herpes Simplex virus and often occurs in children.
2. Blisters, erosions and crusting may be seen on the lips and buccal mucosa. Commonly, the child also has fever, malaise and enlarged lymph nodes.
3. It is infectious.
4. Severe attacks may require oral antiviral agent. It usually takes 2 weeks for the blisters and erosions to clear.
5. Recurrent attacks can occur but the skin lesions are usually less severe.

   

   Herpetic gingivostomatitis

Apthous Ulcers

• It is a troublesome condition that affects normal individuals.
• It presents with recurrent episodes of small painful ulcers on the tongue and/or buccal mucosa, each episode lasting one to several weeks before healing.
• For some patients, it may be a manifestation of iron, folate or vitamin B1 2 deficiency.
• Symptomatic treatment may be given with anti-inflammatory analgesic/ anaesthetic gels.
• They can be treated with topical steroid gel. More severe cases may require oral medication.

Oral Lichen Planus

• Oral lichen planus appears as white streaks in a lace-like pattern on the tongue and/or buccal mucosa. It is usually associated with purplish skin lesions on the body especially around the wrists and ankles.
• The oral lesions may be itchy, painful or asymptomatic.
• A biopsy is usually taken to confirm the diagnosis and to exclude malignant transformation.
• Oral lichen planus is treated with a topical steroid gel.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

National Skin Centre. Singapore