Drug-induced oral ulcer - Oral Mucosal Lesion
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
T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter
403665005 – Drug-induced oral ulceration
Differential Diagnosis & Pitfalls
- Lichen planus, nondrug induced
- Herpes simplex virus – Primary infection and secondary infection in immunocompromised individuals present with intraoral ulceration.
- Erythema multiforme
- Reactive infectious mucocutaneous eruption (RIME)
- Aphthous ulcers
- Behçet syndrome
- Pemphigus vulgaris, nondrug associated
- Lupus erythematosus (see also oral lupus erythematosus)
- Mucous membrane pemphigoid
- Epidermolysis bullosa acquisita
- Paraneoplastic pemphigus
- Contact stomatitis (eg, artificial cinnamon flavoring)
- Acute graft-versus-host disease
Drug Reaction Data