15 May 2017

ပါးစပ္အတြင္းထဲတြင္ အျဖဴေရာင္ အဖတ္မ်ား ရွိေနလွ်င္ Candidiasis ေရာဂါ၊ တေစးမိႈေရာဂါေၾကာင့္ ေရာင္ယမ္းျခင္း၊ ခုခံအား က်ဆင္းေနသူမ်ား၊ AIDS ေရာဂါရွင္မ်ားႏွင့္ ကင္ဆာေရာဂါသည္မ်ား၊ ဆီးခ်ိဳေ၀ဒနာရွင္မ်ားႏွင့္ ပ႒ိဇီ၀ ပိုးသတ္ေဆးမ်ားကို မွီ၀ဲေနသူမ်ား၊ ဓါတုပစၥည္းမ်ားေၾကာင့္ အေရျပားေလာင္ကြ်မ္းျခင္း၊ နီကိုတင္းေၾကာင့္ ျဖစ္ေသာ ေရာင္ယမ္းမႈတုိ႔ေၾကာင့္ ျဖစ္တတ္သည္။

ကုသျခင္း
အျဖဴေရာင္ အဖတ္မ်ားသာရွိလွ်င္ မိႈေၾကာင့္ အျဖစ္မ်ားျပီး Nystatin (သုိ႔) Clotrimazole လိမ္းေပးျခင္း၊ Ketoconazole (သို႔) uconazole ေသာက္သံုးျခင္းတုိ႔ျဖင့္ ေပ်ာက္ကင္းႏိုင္ျပီး တစ္ခါတစ္ရံ Herpes Virus ကို သတ္ရန္ Acyclair လည္း လိုအပ္လွ်င္ သံုးစြဲရသည္။ အရမ္းဆိုးရြားေသာ အခါ၌ Steroid လိမ္းေဆး လိမ္းရသည္။ ကြ်မ္းက်င္ ဆရာ၀န္ႏွင့္ ျပ၍ ကုသျခင္းမွာ အေကာင္းဆံုးျဖစ္သည္။ အေသးစိတ္ကို English လိုတြင္ ဖတ္ရႈႏုိင္ပါသည္။

 

Stomatitis-Management and Treatment

DEFINITION
Stomatitis is inflammation involving the oral mucous membranes.

PHYSICAL FINDINGS AND CLINICAL PRESENTATION
White lesions
● Candidiasis (thrush)
● Caused by yeast infection (Candida albicans)
● Examination: white, curdlike material that when wiped
off leaves a raw bleeding surface
● Epidemiology: seen in the very young and the very old,
those with immunodefi ciency (AIDS, cancer), persons with
diabetes, and patients treated with antibacterial agents

● Other

● Leukoedema: fi lmy opalescent-appearing mucosa, which can be reverted to normal appearance by stretching . This condition is benign.
● White sponge nevus: thick, white corrugated folds involving the buccal mucosa. Appears in childhood as an autosomal dominant trait; benign condition
● Darier’s disease (keratosis follicularis): white papules on the gingivae, alveolar mucosa, and dorsal tongue. Skin lesions also present (erythematous papules); inherited as an autosomal dominant trait
● Chemical injury: white sloughing mucosa
● Nicotine stomatitis: whitened palate with red papules
● Lichen planus: linear, reticular, slightly raised striae on buccal mucosa . Skin is involved by pruritic
violaceous papules on forearms and inner thighs.
● Discoid lupus erythematosus: lesion resembles lichen planus
● Leukoplakia: white lesions that cannot be scraped off ; 20% are premalignant epithelial dysplasia or
squamous cell carcinoma.
● Hairy leukoplakia: shaggy white surface that cannot be wiped off ; seen in HIV infection, caused by EBV.
source: imgur.com
Red lesions
● Candidiasis may present with red instead of the more frequent white lesion (see “White Lesions”). Median rhomboid glossitis is a chronic variant.
● Benign migratory glossitis (geographic tongue): area of atrophic depapillated mucosa surrounded by a keratotic border ; benign lesion, no treatment required
● Hemangiomas
● Histoplasmosis: ill-defi ned irregular patch with a granulomatous surface, sometimes ulcerated
● Allergy
● Anemia: atrophic reddened glossal mucosa seen with pernicious anemia
● Erythroplakia: red patch usually caused by epithelial dysplasia or squamous cell carcinoma
● Burning tongue (glossopyrosis): normal examination; sometimes associated with denture trauma, anemia, diabetes, vitamin B12 defi ciency, psychogenic problems.
Dark lesions (brown, blue, black)
● Coated tongue: accumulation of keratin; harmless condition that can be treated by scraping
● Melanotic lesions: freckles, lentigines, lentigo, melanoma,
Peutz-Jeghers syndrome , Addison’s disease
● Varices
● Kaposi sarcoma: red or purple macules that enlarge to form tumors; seen in patients with AIDS
Raised lesions
● Papilloma
● Verruca vulgaris
● Condyloma acuminatum
● Fibroma
● Epulis
● Pyogenic granuloma
● Mucocele
● Retention cyst .
source: imgur.com
Blisters
● Primary herpetic gingivostomatitis
● Caused by herpes simplex virus type 1 or, less frequently,

type 2
● Course: day 1—malaise, fever, headache, sore throat, cervical
lymphadenopathy; days 2 and 3—appearance of vesicles
that develop into painful ulcers of 2 to 4 mm
in diameter; duration of up to 2 weeks
● Recurrent intraoral herpes: rare, recurrences typically involve
only the keratinized epithelium (lips).
● Pemphigus and pemphigoid
● Hand-foot-and-mouth disease : caused by
coxsackievirus group A
● Erythema multiforme
● Herpangina: caused by echovirus
● Traumatic ulcer
● Primary syphilis
● Perlèche (or angular cheilitis)
● Recurrent aphthous stomatitis (canker sores)
● Behçet’s syndrome  (aphthous ulcers, uveitis,
genital ulcerations, arthritis, aseptic meningitis)
● Reiter’s syndrome (conjunctivitis, urethritis, arthritis, with occasional oral ulcerations)
● Unknown cause
● Course: solitary or multiple painful ulcers may develop simultaneously and heal over 10 to 14 days. The size of the
lesions and the frequency of recurrences are variable.
DIAGNOSTIC WORKUP
White lesions
● Candidiasis (thrush) diagnosis: ovoid yeast and hyphae seen in scrapings treated with KOH culture
Blisters
● Exfoliative cytology
● Viral culture
● Immunofl uorescence for herpes antigen 340
92 Section 3: Eyes, ears, nose, oral cavity, and neck.
TREATMENT
White lesions
● Candidiasis (thrush) treatment: topical with nystatin or
clotrimazole; systemic with ketoconazole or fl uconazole
Blisters
● Supportive
● Consider acyclovir Recurrent intraoral herpes
● Topical corticosteroids or systemic steroids for severe cases

Contact

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ceomoenaymin@mmcities.com

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