Chronic Ulcerative Stomatitis (CUS) as an Interdisciplinary Diagnostic Challenge: A Literature Review
Abstract
:1. Introduction
2. The Autoimmune Pathogenesis
3. Clinical Symptoms
4. Histopathological Presentation
5. Diagnostics and Differentiation
6. Treatment Methods
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Major Criteria | Minor Criteria |
---|---|
Clinical features
| Clinical features
|
DIF analysis
| Histopathology
|
IIF analysis
| |
Laboratory findings
| |
Therapy
|
Chronic Ulcerative Stomatitis (CUS) | Erosive Oral Lichen Planus (OLP) | |
---|---|---|
Clinical symptoms | Oral non-healing ulcerative lesions with subtle white reticular striations located on the tongue, the buccal mucosa, and the gingival tissues (desquamative gingivitis), mostly symmetrical. | Oral mucosa lesions manifested as reticular, including white lines, plaques, and papules; atrophic or erythematous; erosions and ulcerations; mostly symmetrical, located on the buccal mucosa and lateral surface of the tongue, gingiva (desquamative gingivitis) and labial mucosa. |
Histopathology | Sub-epithelial separation from underlying connective tissue, atrophic epithelium, and inflammatory infiltrate with increased number of plasma cells and lymphocytes (non-specific). | Basal layer degeneration and apoptotic bodies; CD4+ T and CD8+ T cells (non-specific). |
Direct immunofluorescence (DIF) | SES-ANA speckled pattern, located in the basal layer and the bottom three layers of cells. | Fibrillar pattern of fibrin deposition at the basement membrane zone. |
Treatment | Chloroquine and hydroxychloroquine combined with corticosteroids or a single drug treatment. | Reticular OLP—observation; erosive OLP—pharmacological treatment (local and systemic corticosteroids implementation, calcineurin inhibitors or retinoids). |
Clinical symptoms | Diagnostic tests | Treatment | |
---|---|---|---|
Azzi et al. [6] | Painful oral erosions and/or ulcers most often located on the buccal mucosa, the gingiva (desquamative gingivitis), and the tongue. | DIF: SES-ANA deposition, mainly composed of IgGs, in cells of the basal layer and the bottom three layers of cells. | Low doses of antimalarial drugs combined with corticosteroids administrated for a prolonged time. |
Islam et al. [7] | Oral erosive or ulcerative lesions located on the tongue, the buccal mucosa, and the gingival tissues (desquamative gingivitis). | DIF: a speckled or finely granular pattern of IgG limited to the basal and parabasal layers of the epithelium, often perinuclear distribution. | Steroidal combination therapy and/or dose regulation of hydroxychloroquine. |
Mustafa et al. [9] | Persistent or recurrent painful erosive, ulcerative, vesicular lesions, predominately affecting the tongue, the buccal mucosa, and the gingiva. | DIF: a speckled, finely granular pattern of IgG deposition in the nuclei of keratinocytes. SES-ANA signal is confined to the basal cells and the lower third of the spinous layers. | The same as other oral mucosa erosions and ulcers (no specific treatment was described). |
Ko et al. [10] | Oral erosions or ulcerations with periods of exacerbation and remission; the tongue, buccal mucosa, and gingiva are the most commonly affected. | DIF: a speck-led pattern of IgG deposition in the nuclei of keratinocytes limited to the lower layers of the oral squamous epithelium. The presence of SES-ANA distinguishes CUS from oral LP. | No response to corticosteroids. |
Solomon et al. [12] | Oral erosive or ulcerative lesions that ale most often present on the tongue, then on the buccal mucosa and gingiva (desquamative gingivitis). | DIF: a speckled, finely granular pattern of IgG deposition in the nuclei of keratinocytes. The SES-ANA signal is confined to the basal cells and lower third of the Malphigian layers. | A combination of small doses of steroids and hydroxychloroquine. |
Stoopler et al. [24] | Symptomatic chronic oral ulcers: Wickham’s striae, erythema, and ulceration which commonly affect the buccal mucosa, the tongue, and the gingiva (desquamative gingivitis). | DIF: a speckled pattern of IgG deposition in keratinocyte nuclei limited to the lower layers of the oral squamous epithelium; the presence of SES-ANA antibodies. | Promoting healing, symptom relief, mitigating risks of secondary infection, hydroxychloroquine. No response to corticosteroids. |
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Cichońska, D.; Komandera, D.; Mazuś, M.; Kusiak, A. Chronic Ulcerative Stomatitis (CUS) as an Interdisciplinary Diagnostic Challenge: A Literature Review. Int. J. Mol. Sci. 2022, 23, 13772. https://doi.org/10.3390/ijms232213772
Cichońska D, Komandera D, Mazuś M, Kusiak A. Chronic Ulcerative Stomatitis (CUS) as an Interdisciplinary Diagnostic Challenge: A Literature Review. International Journal of Molecular Sciences. 2022; 23(22):13772. https://doi.org/10.3390/ijms232213772
Chicago/Turabian StyleCichońska, Dominika, Dominika Komandera, Magda Mazuś, and Aida Kusiak. 2022. "Chronic Ulcerative Stomatitis (CUS) as an Interdisciplinary Diagnostic Challenge: A Literature Review" International Journal of Molecular Sciences 23, no. 22: 13772. https://doi.org/10.3390/ijms232213772