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Screening mouth for chronic GVHD

Evaluation

Patient-reported symptoms and signs

  • Dryness
  • Chapped lips
  • Ulcers
  • Swelling, redness, pain and/or bleeding of gums
  • Sensitivity to spicy foods, toothpaste or soda pop
  • Pain

Clinical examination

Visual inspection of the entire mouth

Diagnostic testing

Oral biopsy

Clinical manifestation

Clinical manifestation
Description

Lichen planus-like changes

Hyperkeratotic white lines and lacy-appearing lesions on the buccal mucosa and tongue, palate or lips

Xerostomia*

Abnormal dryness of the mouth

Mucoceles*

Vesicle-like or raised masses due to minor salivary gland inflammation and damage

Mucosal atrophy*

Thinning of mucosal tissue

Pseudomembranes*

Loosely adherent fibrinous exudate on the surface of a mucous membrane

Ulcers*

Open sore inside mouth caused by a break in mucous membrane or epithelium on lips or surrounding mouth

Erythema***

Severity of erythema or “redness” can vary from mild to severe

Gingivitis***

Mucosal fiber damage causes smooth/ inflamed gingival surface, in contrast to the dimpled or stippled appearance of normal gingivae. Entire width of the attached gingivae will be erythematous

Mucositis***

Inflammation of mucous membrane

Pain***

N/A


* Distinctive but insufficient alone to establish an unequivocal diagnosis of chronic GVHD without further testing or additional organ involvement.

** Rare, controversial, or non-specific features of chronic GVHD.

*** Common in both acute and chronic GVHD.

Photo Atlas

This photo atlas contains pictorial representations of various clinical manifestations of chronic GVHD

  • Lips with grey spots and cracks at edges of mouth

    Lichen planus

    Lichenoid changes extending from the labial mucosa to the lip. Cheilosis (surface scaling and fissures in the corners of the mouth) is also present.

  • Roof-of-mouth with small white patches

    Mucoceles

    Numerous vesicle-like mucoceles are seen along the center of the soft palate. Patchy white lichenoid hyperkeratosis and interspersed moderate erythematous changes are also evident across soft palate.

  • Inside of lower lip with chapped skin and discoloration

    Erythema

    Chapping and erythema of the vermillion lip. Erythema of labial mucosa.

  • Side of mouth's inside featuring patchy textures

    Erythema, hyperkeratinization

    Patchy erythema (arrows) and sheet-like hyperkeratinization (black outline). Also note atrophy of buccal mucosal tissues.

  • Inside of mouth featuring several types of ulcerations

    Erythema, ulcerations, hyperkeratinization

    Mixed pseudomembranous fibrin exudate (light green arrows). Lichenoid hyperkeratotic changes (white arrows) involving the buccal mucosa. Erythema (black outline) surrounding pseudomembranous ulcerations.

  • Inside of mouth featuring several white ulcers

    Ulcerations

    White patchy pseudomembranous ulcerations.