D/D of erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis

Source: Handbook of Pediatric Dentistry, Third Ed

Further Reading/Reference: https://books-library.net/files/download-pdf-ebooks.org-1519330145Iz3C6.pdf

FOCAL EPITHELIAL HYPERPLASIA(HECK DISEASE)

HPV- induced local epithelial hyperplasia.

ETIOLOGY

Caused by HPV-B and HPV-32

CLINICAL FEATURES

SEX- no gender prediliction

AGE- Children

SITE- labial, lingual, buccal mucosa.

clinical presentation

  • LESION-
    • Papular in nature
    • broad based
    • same colour as skin-pale/white.
  • 0.3-1 cm, discrete ,well demarcated plaques
  • smooth surfaced/flat topped are commonly seen.
  • they cluster closely together that they give COBBLE STONE/FISSURED APPEARANCE.

HISTOLOGIC FEATURES

  • ACANTHOSIS of oral epithelium.
  • RETE RIDGE FORMATION
    • normal
    • but are indented, confluent and club-shaped
  • MITOSOID CELL
    • Result from viral alteration of the cells.
  • PAPPILARY PROJECTIONS.

TREATMENT

  • Conservative excisional biopsy.
  • Spontaneous regression is observed.

FORDYCE GRANULES

A developmental anomaly characterized by heterotrophic collections of sebaceous glands at various sites in oral cavity.

ETIOLOGY

  • Results from inclusion in oral cavity of ectoderm having some potentialities of skin in course of development of maxillary and mandibular process during embryonic life.

CLINICAL FEATURES

  • SEX- no gender prediliction
  • AGE- adults
  • SITE- Oral mucosa

clinical presentation

  • Small yellow spots either discreatly seperated/forming relatively large plaques-projecting slightly above the surface of the tissue.
  • bilaterally symmetrical pattern.
  • most common sites include-
    • oral mucosa
    • lips
    • retromolar area
    • tongue
    • gingiva
    • frenum
    • palate

HISTOLOGIC FEATURES

  • Lobules of sebaceous duct beneath the epithelium.
  • sebaceous cells are polygonal with centrally located nucleus and foamy cytoplasm.
  • these sebaceous glands are unassociated with hair follicles.
  • may show keratin plugging.

TREATMENT

No treatment is required.