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RED AND PURPLE LESIONS
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VASODILATION
VASCULAR PROLIFERATION
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CLINICAL CATEGORIES
• FOCAL
• DIFFUSE/MULTIFOCAL
• PETECHIAL
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FOCAL RED/PURPLE LESIONS
• Nonspecific mucositis• Ecchymosis/Hematoma• Hemorrhagic Mucocele• Erythroplakia• Hemangioma• Varix• Reactive Proliferations• Kaposi’s sarcoma
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NONSPECIFIC MUCOSITIS• A nonspecific focus of inflammation due to
trauma, chemical injury, thermal injury• Cause/Effect relationship• White sloughing component may be present• Microscopically: nonspecific chronic or subacute
inflammation in the mucosal connective tissue, increased vascularity with vasodilation
• Diascopy is positive
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NonSpecific Mucositis
TRAUMA, BURNS, IRRITATION, ETC.
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Macular Hemangioma• Macular vrs Nodular (Racemos)• Childhood onset• Spontaneous resolution during second decade
for the majority• Tongue, lips, buccal mucosa• Diascopy is positive unless thrombosis has
become extensive• May have thrombi and phleboliths• Microscopic: Capillary, Cellular, Cavernous• Tx: Tincture of Time, excision, laser, sclerosing
agents, Tattooing
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Hemangiomas
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Varix• Adult Onset• Precedent Trauma• Lower Lip and Vestibule• Red and Purple• Micro: similar to hemangioma; many show
thrombi and some have intravascular papillary proliferations akin to a pyogenic granuloma
• Tx: Excision, laser
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Varix
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Reactive Lesions• All are tumefactive• Exuberant proliferations of granulation
and/or fibrous tissues• Pregnancy association• Trauma and irritation
– Pyogenic Granuloma (typically red)– Peripheral Ossifying Fibroma (pink or red)– Peripheral Giant Cell Granuloma
(purple/red/blue)
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Reactive Proliferations
Pyogenic Granuloma
Peripheral Ossifying Fiboma
Peripheral Giant Cell Granuloma
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Ecchymosis/Hematoma• Post-trauma, Post-injection into artery• Flat or raised and nodular• Variagated coloration red, blue, brown• Rule out coagulopathy or platelet disorder
– Prothrombin Time (INR), Partial Thromboplastin Time
– Platelet count and function test– Bleeding/Clotting Times
• Tx: None. Resolution in 10 days
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Ecchymosis/Hematoma
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PETECHIAL HEMORRHAGE• Traumatic (Suction) Petechia
– Infectious Mononucleosis• Thrombocytopenia
– Idiopathic thrombocytopenic purpura– Leukemia– Pancytopenia– Chemotherapeutic drugs
• Thrombocytopathia– Hereditary Platelet adhesion molecule defects– Acquired, Antithrombotic drugs
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Petechial Hemorrhages
Focal capillary red cell extravasation
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(Idiopathic) Thrombocytopenic Purpura
ITP in HIV patient TP of lips and skin in patient with leukemia and leukemic gingivitis
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Hereditary Hemorrhagic Telangiectasia
• An autosomal dominant disorder• Vascular wall defect with vasodilation• Nasal and oral mucosal petechial like
lesions• Epistaxis
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HHT
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Kaposi’s Sarcoma• HIV infected males• Extremely rare in nonimmuno-compromised
patients (elderly males)• Typically multifocal, yet may be a solitary red or
purple macule• Causative agent: Kaposi’s Sarcoma Virus
(Herpesvirus type 8)• Microscopically and angiosarcoma• Lesions are preventable when patients are
taking HIV triple therapy
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Kaposi’s Sarcoma
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MULTIFOCAL & DIFFUSE RED LESIONS
• Bullous/Erosive Disease– Lichen Planus– Mucous Membrane Pemphigoid– Lupus Erythematosus– Pemphigus Vulgaris– Erythema Multiforme
• Allergic Stomatitis• Viral Vesicular Eruptions• Candidiasis (erythematous)• Nonspecific, puberty and pregnancy gingivitis• Leukemic gingivitis• Foreign body gingivitis• HIV associated Gingivitis• Benign Migratory Glossitis• Erythema Migrans• Radiation/Chemotherapy Mucositis• HIV associated Kaposi’s Sarcoma• Blue Rubber Bleb Nevus Syndrome (angiomas)• Trigeminal Angiomatosis & Sturge Weber syndrome
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Bullous Desquamative Diseases
Erosive lichen planus Mucous membrane pemphigoid
Pemphigus vulgaris
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Erythema Multiforme
• Drug Allergens (e.g.: sulfa), post herpetic
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Viral Vesicular Eruptions
Primary herpes
Recurrent herpes
Shingles
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Candidiasis• Denture Sore Mouth PAS
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Gingivitis
• Nonspecific, plaque induced• ANUG• Pregnancy associated• Puberty associated• Foreign body (restorative abrasives)• HIV associated• Leukemic infiltrates
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Acute Necrotizing Ulcerative Gingivitis
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Gingivitis
Puberty gingivitis Erythematous enlargement in leukemia
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Foreign Body Gingivitis• Abrasives (finishing
stones, discs)
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Foreign Body Gingivitis
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HIV Gingivitis
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Benign Migratory Glossitis
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Erythema Migrans
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Post Radiation Mucositis
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HIV – Kaposi’s Sarcoma
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Erythroplakia
• Leukoerythroplakia
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Erythroplakia: Dysplasia
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Encephalotrigeminal Angiomatosis
• Sturge Weber Syndrome• Facial, sometimes oral, “port wine stain”• Angiomas are diffuse and macular, yet
may have foci of nodularity• Tram line calcifactions seen on skull films>
represent vascular wall calcium deposits• CNS angiomas• Epilepsy
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Encephalotrigeminal Angiomatosis• Sturge Weber Syndrome