Some pediatric oral lesions carry serious consequences

Key Points

Montreal - Although most oral lesions observed in children pose little health risk, some of these lesions may be severe and followed by permanent sequelae, an expert says. And some pediatric oral lesions can provide clues to the presence of a systemic disease, she adds.

In a recent review of 25 pediatric cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) spectrum disorders, 52 percent - including eight of 14 with SJS and four of four with TEN - developed persistent cutaneous, adnexal, ophthalmic, genital or oral sequelae such as chronic cheilitis (Marcoux D, Auger I. Unpublished).

Accordingly, says Danielle Marcoux, M.D., "Care should be given to oral hygiene even after the acute phase" of SJS-TEN. She notes, however, that many patients are lost to follow-up after being discharged from the hospital. Therefore, there is a risk of complications going unnoticed. Dr. Marcoux is associate professor of pediatric dermatology, University of Montréal and CHU Sainte-Justine, Montréal.

Infantile hemangiomas

Similarly, she says complications of tattoos can include various dermatoses: allergic, granulomatous/sarcoid/foreign body reaction, lichenoid (red, mercury, nickel dyes; Corazza M, Zampino MR, Montanari A, et al. Contact Dermatitis. 2002;46(2):114-115) and sclerodermiform. Along with infection, other tattoo complications can include scar/keloid formation, lymphadenopathy and Koebner phenomenon.

At the other end of the pediatric spectrum, infantile hemangiomas typically present a few weeks to one month after birth. They occur in 2.5 percent of full-term babies, though the percentage in premature babies is higher, Dr. Marcoux says. "They are also more common in twins," she says.

Though infantile hemangiomas are usually autoinvolutive, ulceration is the most frequent complication, occurring in 5 to 15 percent of infantile hemangiomas, usually during the proliferative phase at age 3 to 4 months, Dr. Marcoux says. The lips and perineal areas are at highest risk.

"Propranolol appears to be an effective new treatment for ulcerated hemangiomas of the lips, which, if untreated, can leave scars and lip deformities after they heal," she says.

Propranolol (2 mg/kg) stops the proliferative phase and speeds the involution phase by promoting vasoconstriction, downregulating expression of VEGF and bFGF and inducing apoptosis (Cohen L, Powell J, Hatami A, et al. Review of ulcerated hemangiomas: Efficacy of becaplermin gel, topical morphine, pulsed dye laser, propranolol. Poster presented at: 18th International Workshop on Vascular Anomalies; April 21-24, 2010; Brussels), she says. At press time, Dr. Marcoux adds, "My group at the Vascular Anomaly Clinic at Sainte-Justine Hospital is performing some studies on the treatment of hemangiomas with propranolol."