19 Red and purple lesions: Desquamative gingivitis, mucositis

Desquamative gingivitis

Definition: Desquamative gingivitis (previously called gingivosis) is a clinical term for persistently sore, red glazed, or red and ulcerated gingivae.

Prevalence (approximate): Fairly common.

Age mainly affected: Middle-aged or older.

Gender mainly affected: F > M.

Etiopathogenesis: Desquamative gingivitis is not a disease entity but usually a manifestation of atrophic or erosive lichen planus or mucous membrane pemphigoid, and occasionally seen in pemphigus or other dermatoses. It can also be due to sodium lauryl sulfate, allergic reactions, linear IgA or other subepithelial immune blistering diseases, or unknown causes.

Diagnostic features

History

Oral: Persistent gingival soreness, worse on eating, especially spices.

Extraoral: There may be a rash or blisters if the patient has a dermatosis.

Clinical features

Oral: Red and glazed (patchy or uniform) gingivae are seen, especially labially (Figure 19.1). Gingival erythema blurs the distinction between the normally coral pink attached gingivae and the more red vestibular mucosae. The erythema is exaggerated where oral hygiene is poor. Gingival margins and edentulous ridges tend to be spared.

Other oral lesions of dermatoses may be associated (e.g. blisters, erosions or white lesions).

Extraoral: Cutaneous lesions of dermatoses may be associated.

Differential diagnosis: Necrotizing ulcerative gingivitis, plasma cell gingivitis, psoriasis, mechanical chronic trauma.

Investigations: The diagnosis is usually obvious from the history and clinical findings. Nikolsky sign may be positive, but biopsy and immunostaining are often needed to establish the precise cause.

Management

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