acute multiple bleeding ulcers of mouth: erythema multiforme

We all have experienced ulcers in our mouth at some point or the other. Though all the ulcers occurring in the mouth or our oral cavity are painful and come with bad experiences but some of them do not lead us to eat or even swallow our food. A drooling blood pooled saliva even make the conditions worsen.
Such ulcers are large in size, irregular in shape, present till deeper membranes and bleed frequently and freely. Such type of presentation is seen extensively on the lips in a full blown case, tongue and other areas of mouth too are involved. Slough is found on the wounds formed due to the rupture of the upper layer of such ulcers called as hemorrhagic crusting. Inflammatory signs like redness, pain is experienced by the patient which can keep on worsening.

Before moving further, let’s first know about the reasons behind such condition. It can be immune related, or due to intake of certain drugs like phenylbutazone, digitalis, birth control pills etc. Even some micro-organisms like mycoplasma pneumonia, herpes simplex virus are found to be the reason behind such ulcers. Apart from this, radiation therapy, ulcerative colitis can also be the reason behind such ulcers. Hence, there can be multiple factors behind the formation of such ulcers in your oral cavity. Hence, a proper history of the patient in regard to above factors become very important and it becomes the duty of the patient to let know all his medical history to his/her dentist/doctor.
Such types of ulcers are usually seen in the young adults or children and rarely to be seen after fifty years of age. Also, males are more prone for such ulcers when compared to the females. These occur acutely and fever and malaise go hand in hand. Sometimes, within 24 hours, it can be explosive and extensive lesions occur throughout the mouth.
The ulcers or lesions in the mouth start as bullae present on an erythematous base which soon get rupture to form ulcers. Such presentation may be non-specific when present on the skin. A typical bull’s eye lesion or target lesion are characteristically present in erythema multiforme.
The ulcers of erythema multiforme can be minor, major form or more severe form that is medically known as toxic epidermal necrolysis. All the above explained presentation accompanied with biopsy of the lesion helps in confirming the disease.
Now, the question arises that how can we distinguish it from other diseases with almost similar presentation. The answer to this question is explained below.
1. Viral lesion like primary herpetic gingivostomatitis: the ulcers here are small, round symmetrical contrary to the ulcers of erythema multiforme that are much larger in size and deeper in their presentation. Also, the involvement of gingival or the gums is rare to be seen in erythema multiforme
2. Pemphigus vulgaris: inflammation is vey less seen here
3. Allergic reactions: target lesions are absent in the allergies
4. Erosive lichen planus: the onset is not as acute as in erythema multiforme. Also, reticular or white net like presentation is common in lichen planus
5. Xerostomia: dryness of mouth is seen

Are such ulcers curable? Yes
Though the lesion are self-limiting and heal themselves in few days but a proper guidance and prescription of a dentist always helps in relieving the pain of the disease and escaping from any complications.
1. Some topical application of the steroid cream always help
2. If the cause behind the ulcers is drug, identify and discontinue it on an emergency basis.
3. The patient should rehydrate himself with water and take soft liquid diet so as not to alleviate the pain further
4. Topical anaesthetic mouthwash also helps in relieving the pain
5. Systemic steroids also helps in the removal of symptoms and the dose should be tapered gradually after all the symptoms wear off
6. Antiviral like acyclovir can also be given if the eythema multiforme ulcers are associated with herpes simplex virus

Hence, the disease is definitely curable and the patient should not panic if ever experienced such types of ulcers. A visit to a proper dentist will prove helpful in relieving the patient from such kind of painful and annoying experience.

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