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Drug-induced oral ulcer - Oral Mucosal Lesion
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Drug-induced oral ulcer - Oral Mucosal Lesion

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Contributors: Susan Burgin MD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
Other Resources UpToDate PubMed

Synopsis

Drug-induced oral ulcerations, erosions, or necrosis of oral mucous membrane tissue can be triggered by systemic or locally delivered medications.

Pathogenetic mechanisms include focal irritation due to low pH (aspirin), allergic hypersensitivity (gold, NSAIDs), or cytotoxicity (antimetabolites).

Medications with strong evidence for antimetabolic injury of oral mucosal epithelium include chemotherapeutic agents such as 5-fluorouracil, 6-mercaptopurine, methotrexate, bleomycin, doxorubicin, daunorubicin, docetaxel, topotecan, and actinomycin-D. More recently, everolimus, an mTOR inhibitor, has been recognized to be a cause of stomatitis and oral ulceration.

Immune-mediated mechanisms, resulting in an ulcerative lichenoid reaction, have been described for a wide range of systemic medications, including captopril, carbamazepine, methyldopa, naproxen, indomethacin, zomepirac, lithium, and prochlorperazine, although this is an ever-expanding list. Similar lesions can be induced locally by mercury salts associated with large deteriorating amalgam (silver) dental fillings that contact the buccal or lingual mucosa.

Drugs such as penicillamine and captopril have been implicated in the causation of pemphigus vulgaris, which usually has a mucosal-predominant presentation.

Stevens-Johnson syndrome (SJS) / toxic epidermal necrolysis (TEN) frequently has oral mucosal findings including erosions, ulceration, and hemorrhagic crusting of the lips. SJS / TEN is considered a potentially life-threatening emergency.

Additional related topics: Chemotherapy-induced mucositis and Oral lichen planus

Codes

ICD10CM:
T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter

SNOMEDCT:
403665005 – Drug-induced oral ulceration

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 06/28/2018
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Drug-induced oral ulcer - Oral Mucosal Lesion
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Drug-induced oral ulcer : Oral erosions
Clinical image of Drug-induced oral ulcer
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