Oral Erosions

Abstract

The differential diagnosis of persistent oral erosions includes erosive lichen planus (LP), mucosal pemphigoid (MP), and pemphigus vulgaris (PV). In case of acute onset strong consideration would be given to oral or mucosal erythema multiforme; hand, foot, and mouth disease, and other rare viral and bacterial oral infections. If the lesions are ulcers, then aphthosis is the preferred diagnosis.

The likelihood of making the right diagnosis solely based on clinical grounds is at best moderate. Vesicles may rarely be seen in all three disorders. The degree of pain is probably worst in patients with PV, but cannot be relied upon in the clinical evaluation of patients.

Both erosive LP and PV favor the buccal mucosa. PV may be limited to the buccal mucosa, especially the posterior part. Erosive LP may be limited to the buccal mucosa, often favoring the anterior portion and occasionally extending to the corner of the mouth and lips.

Suprabasal acantholysis is diagnostic of PV. The differentiation between erosive LP and MP may sometimes not be straightforward.