Case #9

A 42-year-old female visited a dentist for a routine examination and prophy. Oral examination revealed diffuse red-and-white areas on the lower labial mucosa.

Sep 1st, 1997

A 42-year-old female visited a dentist for a routine examination and prophy. Oral examination revealed diffuse red-and-white areas on the lower labial mucosa.

Joen Iannucci Haring, DDS, MS

History

The patient was questioned concerning the lesions on the labial mucosa. The patient claimed that she was unaware of the affected areas and was uncertain of how long the lesions had been present. She denied any recent trauma or thermal injury to the area. She also denied any pain, burning, or sensitivity associated with the labial mucosa.

The patient visited her dentist annually for routine dental treatment and checkups. The red-and-white areas had not been noted at previous examinations. At the time of the dental appointment, the patient appeared to be in an overall good state of health and taking no medications.

Examinations

Physical examination of the head and neck area revealed no enlarged or palpable lymph nodes. The patient`s vital signs were all within normal limits. No significant extraoral findings were noted.

Intraoral examination revealed diffuse red-and-white areas of the lower labial mucosa. Closer examination revealed well-demarcated erythematous areas surrounded by white borders. Further examination of oral tissues revealed no other lesions present.

Clinical diagnosis

Based on the clinical information provided, which of the following is the correct diagnosis?

* erythroplakia

* erythematous candidiasis

* erosive lichen planus

* erythema multiforme

* erythema migrans

Diagnosis

_ erythema migrans

Discussion

Erythema migrans is a benign condition that affects the tongue, buccal mucosa, labial mucosa, and soft palate. The term erythema refers to redness while the term migrans refers to the fact that the lesions move around and change location. Erythema migrans is identical to benign migratory glossitis or geographic tongue (RDH May 1991). The term erythema migrans is now used to describe lesions found on the tongue as well as other soft tissue areas.

The cause of erythema migrans is unknown. Some investigators have suggested environmental factors while others report hormonal imbalances.

Clinical features

Erythema migrans occurs in 1 to 3 percent of the population. Females are affected more frequently than males. Any age group may be affected. Evaluation of the areas is usually sought when the patient notices the unusual appearance of the oral soft tissues.

The lesions of erythema migrans are most frequently found on the anterior two-thirds of the dorsal tongue. Other intraoral sites, such as the buccal mucosa, labial mucosa and soft palate, are infrequently involved. When found on such sites, the involved areas are characterized by areas of erythema surrounded by white, keratotic borders. A circinate pattern is often seen. When multiple areas are involved, the lesions tend to coalesce and produce larger areas of involvement.

The lesions of erythema migrans may remain static or change shape and move to other mucosal sites. The involved areas typically remain in one location for a period of time, then resolve and move to another location, hence the term migrans.

Erythema migrans has a variable duration and may persist for weeks, months, or years, and then disappear. The condition tends to wax and wane. The usual pattern is that of regression and recurrence without apparent cause.

Erythema migrans is almost always asymptomatic and discovered during routine intraoral examination. On occasion, a patient may describe a burning or pain associated with the involved area.

Diagnosis

The diagnosis of erythema migrans is based on its characteristic clinical appearance. No biopsy or special testing is necessary.

Treatment

Erythema migrans is a self-limiting condition and requires no treatment. Reassuring the patient that it is a benign condition is warranted. If the lesions are symptomatic, a topical corticosteroid (e.g. fluocinide gel) may be prescribed for the patient.

Joen Iannucci Haring, DDS, MS, is an associate professor of clinical dentistry, Section of Primary Care, The Ohio State University College of Dentistry.

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