Mouth Issues Seen By a Dermatologist

By Jennell Nelson, MD

Nelson Dermatology

. http://www.nelsonskin.net/

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Mouth Issues Seen By a Dermatologist

In addition to a dentist, oral surgeon and otolaryngologist (ENT) doctors, dermatologists are often seen by patients with a variety of mouth aliments. The most common would be a common cold sore.

Cold sores are caused by herpes type 1 virus and tend to recur in the same locations. It is best treated by an oral antiviral medication like acyclovir. Some of the over-the-counter products like Abreva may help decease the discomfort. The Centers for Disease Control (CDC) discourages use of topical antiviral therapy.

Herpes simplex is caused by one of two types of herpes simplex viruses (HSV). Type 1 is mainly associated with oral and facial infections. Type 2 is mainly associated with genital and rectal infections. Recurrences can be triggered by minor trauma, surgery or procedures to the affected area, upper respiratory tract infections, excess sun exposure, hormonal factors in women (flares are not uncommon prior to menstruation) and emotional stress. If you have more than six outbreaks a year, suppressive oral antiviral therapy for one year is recommended by the CDC.

Mouth sores or ulcerations that are painful and recurrentare called aphthous ulcers or canker sores. The cause ofaphthous mouth ulcers are not well understood. Current thinking is that the immune system is disturbed by some external factor and reacts abnormally against a protein in mucosal tissue. Although most people with aphthous ulcersare healthy, it may relate to genetic factors, family history, other illnesses, lack of sleep, being “run down”, or trauma from an inadvertent bite, sharp crunchy foods or brushing teeth to aggressively.

Symptomatic relief from aphthous ulcers may be obtained by

• Avoidance of hard, spicy, salty or acidic foods.
• Avoidance of toothpaste containing sodium lauryl/laureth sulfate.
• Antiseptic, anti-inflammatory and analgesicmouthwash or spray.

Medical therapy for aphthous ulcers includes corticosteroids, topicalcalcineurin inhibitors, like topicalpimecrolimus ortacrolimus, Nd YAG laser, or silver nitrate cautery. Oral antiviral therapy can be helpful as well.

Lastly, allergic contact dermatitis of the lips is also known as cheilitis. It causes redness, swelling, itching and peeling of the entire mouth. It can be caused by allergic reactions to chemicals in toothpaste, lipsticks and foods. Chemical sunscreens and menthol in lip balms can cause or exacerbate the underlying condition. Antihistamines can be helpful for preventing flare-ups but isolating the cause of the reaction and completely avoiding the cause in the future is the best answer.