PYOSTOMATITIS VEGETANS

By Gary M. White, MD


Pyostomatitis vegetans (PV) is a rare, debilitating disorder of the oral mucosa often found in association with inflammatory bowel disease (IBD), most commonly ulcerative colitis but also Crohn's disease. Cutaneous pustular lesions may be associated and have been termed pyodermatitis (vegetans).

Clinical

Pustules studded along the gingiva are typical. They are said to resemble snail tracks. Lesions are friable and easily lead to erosions. Involvement of the lips, hard and soft palate, vestibule, buccal mucosa and tonsils are also common.

Vegetating plaques in the scalp, face, axilla and groin are characteristic of pyodermatis.

Treatment

Topical and/or systemic steroids are often first line therapy. Strict control of the IBD helps prevent or treat the PV as well. In one report pyostomatitis vegetans responded quickly and dramatically to treatment with 0.1% tacrolimus ointment. Dapsone, azathioprine, mycophenolate mofetil, cyclosporine and infliximab have all been used with some success. Biologic agents may be employed to treat both the IBD and PV.

References

A 58-year-old man presented with “white lesions that looked like pus” on the labial gingiva. The lesions peeled off during tooth brushing, without causing any discomfort. The patient also complained of bloody diarrhea for the past several months. Complete colonoscopy was performed and the diagnosis of Crohn's disease was made. Ann Gastroenterol. 2013; 26(2): 187.

A 27-year-old man with Crohn disease developed pustular lesions on the gums and skin. The condition was controlled with prednisone and dapsone. Ann Dermatol. 2015 Oct; 27(5): 624–625

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