European Journal of Cardiovascular Medicine

The oral mucosa encompasses several key components, such as the lips, palate (hard and soft), uvula, tonsils, floor of the mouth, gums, teeth ¹. Oral lesions are common manifestations of various dermatological diseases encountered on daily basis at OPD clinics. Oral mucosal disorders are often mismanaged due to delayed or incorrect diagnoses, highlighting the need for improved awareness and attention ² .Oral mucosa acts as a window to diagnose both cutaneous and systemic diseases there by making easy and sometimes early diagnosis of various cutaneous dermatoses . The objective of this study is to characterize the clinical and epidemiological features of oral lesions in dermatological patients, facilitating timely diagnosis and management.

A Total of 160 cases within age group of 18-80 years attending the Out Patient Department of DVL at SVRRGGH Tirupati and who gave informed written consent were included in the study during the period of 1 year. All patients fulfilling inclusion criteria with oral manifestations were included, and patients who were comatose, with restricted mouth opening were excluded. A detailed clinical history and examination was done and analyzed along with clinical photographs. While examining about oral lesion the following were given consideration like site, appearance and extent of lesion, lesion margins, floor, base and lymph nodes if any. Investigations like complete blood picture, random blood sugar , KOH mount, Tzanck smear test , gram staining . Biopsy for histopathological study was  done for ambiguous cases

A total of 160 cases within the age group of 18-80 years attending DVL OPD at SVRRGGH , Tirupati were included . Most often cases were predominantly seen in the 31-45 year age group (90 cases), followed by 46-50 years, and least in the 18-30 year age group. While in gender wise  males were more prevalent .. Buccal mucosa was the most common site, and uvula the least common, among the oral dermatoses examined . Most common presentation of oral lesion was erosions and pigmentation with less common presentation being  plaque . Based on the etiology of lesions most common etiology observed was autoimmune conditions 32.5%  followed by infections 13.75 % and miscellaneous conditions 22.5%  and rare causes being Genodermatoses 6.25% involving oral cavity.

Table 3. Classification of Oral Dermatoses and Their Oral Manifestations

In the present study, 160 cases of oral manifestations were documented, with a male predominance of 56% and female 44%. This is similar to Suliman et al 6 (2011, Sudan), who reported 58% males and 42% females, as well as Jain et al 2 (2023; 60% males) and Thete et al 5 (2017; 55% males). Conversely, Roy & Varshney 4 (2011; 62% females), Modi et al 8 (2013; 59% females), and Mandadi et al 3 (2021; 54% females) noted female predominance

The most affected age group in our study was 31–45 years (42%), comparable to Jain  2 (2023; peak 31–40 years, 38%), Thete 5 (2017; 31–40 years, 35%), and Mandadi 3 (2021; 30–50 years, 40%). Suliman 6 (2011)  prevalence with age, particularly after 40 years , while Roy&Varshney 4  (2011) described higher involvement in younger adults (20–30 years, 34%).

Among the oral dermatoses, lichen planus was most frequent presented in our study (11.3%), that aliens with studies of Jain 2  (21.9%), Thete 5 (21.9%), and Mandadi 3 (12.1%). Pemphigus vulgaris (7.5%) and pemphigoid (1.3%) together accounted for 8.8% of cases, which is lower than Roy & Varshney 4 (26.6%) but comparable to Thete 5 (4.8%). Psoriasis (2.5%) was noted less frequently than Thete 5 (31.9%), where it was predominant.

Among autoimmune conditions Systemic lupus erythematosus (3.1%) was observed, lower than Roy & Varshney 4 (17%). Vitiligo (6.9%) showed with similar to Mandadi (15.4%). 3

Genodermatoses disorders such as tuberous sclerosis (1.9%), ectodermal dysplasia (1.3%), neurofibromatosis (1.3%), and xeroderma pigmentosum (1.3%) were seen, matching occasional rare cases described by Mandadi. 3

Infectious lesions were also present. Candidiasis (9.4%) was one of the most common findings, similar to Roy & Varshney 4 (16%) and Mandadi 3 (17.6%), and also reported by Suliman 6 . Viral lesions included herpes labialis (3.1%) and herpes ophthalmicus (1.3%), in comparison with Mandadi (herpes labialis 6.6%) 3 .

Drug-related and inflammatory conditions were represented by Stevens–Johnson syndrome (3.8%), fixed drug eruption (2.5%), and toxic epidermal necrolysis (4.4%), comparable to frequencies in Thete and Mandadi . Actinic cheilitis (4.4%) was similar to Mandadi (3.3%). Aphthous ulcers (5.6%) were less frequent than reported by Roy & Varshney (28.6%) [3 4 5]

Our study documented single cases oral hemangioma involving face , lip and buccal mucosa, suggesting  that vascular lesions, though rare, can occur in the oral cavity. Previous reports, such as D’Souza et al. and Dilsiz et al., described hemangiomas affecting the palate, buccal mucosa, and gingiva, highlighting their clinical significance. 11

Importantly, habits like (smoking , tobacco chewing) were common in our patients presenting with oral pigmentation , discolouration of teeth . This is in supportive of study of Suliman (2011) that reported these habits are linked to oral mucosal changes 6. This is consistent with Roy & Varshney (2011), Thete (2017), Jain (2023), Modi (2013), and Mandadi (2021), who also emphasized that tobacco and smoking habits play a major role in the development of lesions such as leukoplakia, oral submucous fibrosis . Our findings therefore strengthen the established evidence that lifestyle habits significantly influence the occurrence and pattern of oral manifestations. [2 3 4 5 8 ]                                   

 A single case of oral syphilis was recorded in our study, presenting as condyloma lata. This parallels the reports of D’Souza et al. (2019) and Pavlov & Slavova (2004), who each described oral condyloma lata as a key clinical clue to secondary syphilis [12 , 13 ] .

Strengths and Limitations

Strength : It provides a comprehensive assessment of oral manifestations, encompassing both common oral dermatoses and rarer conditions such as like Genodermatoses, vascular anomalies and Kawasaki disease with their oral manifestations . Second, the relatively large sample size (160 cases) allowed identification of uncommon lesions, enhancing clinical relevance.

Limitations : The study was conducted at a single center and diagnostic confirmation relied primarily on clinical evaluation, with limited histopathological verification.

FUNDING : NONE.

CONFLICTS OF INTEREST : NONE..

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