ral Disorder

Definition: Angular cheilitis is an inflammatory lesion at the labial corner of the mouth, and often occurs bilaterally. The condition manifests as deep cracks or splits. In severe cases, the splits can bleed when the mouth is opened and shallow ulcers or a crust may form.
Etiology: The cause is unknown, but the sores of angular cheilitis may become infected by the fungus  or bacteria. Vitamin B and Zinc deficiency has also been associated with angular cheilitis.
Clinical Features: Inflammation, burning, redness, and ulceration or cracks characterize the lip skin care problem of angular cheilitis,. The affected area is often very itchy and painful. In more advanced cases, the cracks can bleed when the mouth is opened. These open lesions may subsequently form a crust as they start to heal or can become infected.
Clinical Approach: Diagnosis is made on history and clinical examination.
Treatment: In mild cases the patient is encouraged not to lick their lips and applying protective paraffin-based ointment (such as Vaseline) or lip balms to the lips.  For more severe angular cheilitis, depending on the cause, antifungal and antibiotic medication (e.g. topical miconazole oral gel that has dual activity), vitamins supplements.

Definition: Canker sores, also called aphthous ulcers, are small, shallow lesions that develop on the soft tissues in your mouth — under your tongue, inside your cheeks or lips, and at the base of your gums.
Etiology: The exact cause of many aphthous ulcers is unknown. Factors that provoke them include citrus (orange juice, lemons, acidic items, etc.), stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies, the foaming agent in toothpaste, and deficiencies in vitamin B12, iron, and folic acid.
Clinical Features: Most canker sores are round or oval with a white or yellow center and a red border. They form inside your mouth — on or under your tongue (soft palate), inside your cheeks or lips, and at the base of your gums. You might notice a tingling or burning sensation a day or two before the sores actually appear.
Clinical Approach: Diagnosis is made on history and clinical examination.
Treatment: Treatment usually isn't necessary for minor canker sores, which tend to clear on their own in a week or two. But large, persistent or unusually painful lesions often need medical care. A number of treatment options exist, ranging from mouth rinses and topical ointments to systemic corticosteroids for the most severe cases.

Definition: Oral hairy leukoplakia (OHL) is a disease of the oral mucosa.This pathology is associated with Epstein-Barr virus (EBV) and occurs mostly in people with HIV.
Etiology: Oral hairy leukoplakia results from infection with the Epstein-Barr virus (EBV). Most people are initially exposed to EBV in childhood — often without having any symptoms. But once you've been infected with EBV, the virus remains in your body for life. Normally, the virus is dormant, but if your immune system is weakened, either from disease or certain medications, it can become reactivated, leading to conditions such as hairy leukoplakia.
Clinical Features: Leukoplakia can have various appearances, but typically first appears as flat, gray or gray-white sores (plaques) — usually on your gums or on the insides of your cheeks and sometimes on your tongue. Over weeks or months, leukoplakia can develop into patches with the following characteristics:

    * White color
    * Thick, rough or wrinkled texture
    * Hardened surface

Clinical Approach: Most often OHL can be diagnosed by examining the patches in your mouth and ruling out other possible causes for your symptoms. Also  a tissue biopsy is done.
Treatment: Not all cases of oral hairy leukoplakia need treatment, and your doctor or dentist may take a wait-and-watch approach. If you need treatment, several options are available:

    * Systemic medications. These include antiviral drugs such as valacyclovir and famciclovir, which prevent the Epstein-Barr virus from replicating but don't eliminate it from your body.                     
    * Topical medications. These include podophyllum resin solution and tretinoin (retinoic acid). When applied topically, it can heal leukoplakic patches, but it may cause some discomfort and affect your sense of taste. In addition, the patches often return several weeks after being treated.

Definition: Herpes labialis is an infection caused by the herpes simplex virus. It leads to the development of small and usually painful blisters on the skin of the lips, mouth, gums, or lip area. These blisters are commonly called cold sores or fever blisters.
Etiology: Herpes labialis is a common disease caused by infection of the mouth area with herpes simplex virus type 1.
Clinical Features: Occurs around the mouth. There are small blisters (vesicles) filled with clear yellowish fluid.  Blisters are raised, red, and painful.
Clinical Approach: Diagnosis is made on the basis of the appearance or culture of the lesion. Examination may also show enlargement of lymph nodes in the neck or groin. Viral culture or Tzanck test of the skin lesion may reveal the herpes simplex virus.
Treatment: Untreated, the symptoms will generally go away in 1 to 2 weeks. Antiviral medications taken by mouth may shorten the course of the symptoms and decrease pain.

Definition: Oral thrush is a condition in which the fungus Candida albicans accumulates on the lining of your mouth causing creamy white lesions, usually on the tongue or inner cheeks.
Etiology: Oral thrush and other candida infections occur when your immune system is weakened by disease (HIV) or drugs such as prednisone, or when antibiotics disturb the natural balance of microorganisms in your body.
Clinical Features: Oral thrush usually produces creamy white lesions on your tongue and inner cheeks and sometimes on the roof of your mouth, gums and tonsils. The lesions, which resemble cottage cheese, can be painful and may bleed slightly when rubbed or scraped.
Clinical Approach: Oral thrush can usually be diagnosed simply by history looking at the lesions, but sometimes a small sample is examined under a microscope to confirm the diagnosis.
Treatment: Oral candidiasis can be treated with topical anti-fungal drugs, such as nystatin, miconazole or amphotericin B. Patients who are immunocompromised, either with HIV/AIDS or as a result of chemotherapy, may require systemic treatment with oral or intravenous administered anti-fungals.

Definition: Oral lichen planus is a chronic autoimmune inflammatory condition affecting the lining of your mouth, usually resulting in characteristic lacy white patches. Oral lichen planus occurs most often on the inside of your cheeks but also can affect your gums, tongue, lips and other parts of your mouth.
Etiology: The exact cause of oral lichen planus isn't known.
Clinical Features: Oral lichen planus may present in the following forms, and is often of mixed types.
1) Reticular lichen planus          
    * Symmetrical white lace-like pattern on buccal mucosa (inner aspects of cheeks)
    * May affect tongue or gums
    * May ulcerate
2) Atrophic/erosive lichen planus          
    * Red lesions often with a whitish border
    * My cause erosions (superficial ulceration)
    * Most often affects the gums and lips
    * Can be very painful
3) Plaque type
    * Usually seen in smokers
    * Confluent white patches similar to oral keratoses

Clinical Approach: Diagnosis is made on history and clinical examination.
Treatment: There's no cure for oral lichen planus. Medical treatment focuses on controlling your pain, reducing lesions and prolonging the periods of time when you're symptom-free. This accomplished with oral and topical steroids.

Definition: Perioral dermatitis is a common facial skin problem in adult women. It rarely occurs in men. It may occasionally affect children. Groups of itchy or tender small red papules (bumps) appear most often around the mouth.
Etiology: The exact cause of perioral dermatitis and/or periorificial dermatitis is not understood. Patients who are susceptible to perioral dermatitis tend to have an oily face, at least in the affected areas.
Clinical Features: Skin lesions occur as grouped follicular reddish papules, papulovesicles, and papulopustules on an erythematous base with a possible confluent aspect. The papules and pustules have mainly perioral locations.  The predominant locations of POD lesions are the perioral area, nasolabial fold, and lateral portions of the lower eyelids.
Clinical Approach: Diagnosis is made on history and clinical examination.
Treatment: Perioral dermatitis responds well to treatment.  Discontinue applying all face creams including topical steroids, cosmetics and sunscreens.(Note: when a steroid cream is discontinued, the rash gets worse for a few days before it starts to improve). A course of oral antibiotics for six to twelve weeks. Normally tetracycline or one of its derivatives is recommended. Topical antibiotics such as erythromycin, clindamycin or metronidazole tend to be less effective.