Red and White Lesions
condition, varying degrees of erythema (redness) are seen around the necrotic margins (see Fig. 8-44 and Plates E, 10 and E, 11). The pyogenic granuloma is frequently reddish with a necrotic white patch of variable size on the surface. Identifying a chronic irritant usually helps to establish the working diagnosis. In mild to moderate cases, allergic mucositis, shows as an inflammatory red plaque. In severe cases, it also has a necrotic white component (Plates C and D). Xerostomia varies in severity and may lead to a generalized erythematous mucositis. In severe cases, necrosis may occur and give a disseminated red and white appearance. Radiation mucositis, also depending on stage and severity, may show erythematous and necrotic components disseminated as patches throughout the oral mucosa (Plate D, 6). Frank blebs that appear white before and after rupture may also be present. The history is usually diagnostic.
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Chemotherapy mucositis usually shows patches of red scattered throughout the mouth. Although necrosis may also be present, it is not usually as prominent in chemotherapy mucositis as in radiation mucositis.
VESICULOBULLOUS LESIONS These lesions are discussed in detail in Chapter 6. Originally surrounded by red rims, these lesions appear white. and the vesicles, or blebs, are intact. When coalesced vesicles rupture, they may retain a white appearance for a while. When the blebs fully rupture and become emptied, their white appearance usually disappears, although the torn fragments of their roof tissue may persist as whitish flaps for a time. Some vesiculobullous conditions that the clinician might expect to see are herpes simplex, both primary and secondary; benign mucous membrane pemphigoid; erythema multiforme; pemphigus and its variants; and occasionally radiation mucositis (see Figs. 6-1, 6-2, 6-5, 6-7, 6-9, and 6-11 and Plates C and D).