An unusual vesiculopustular and vegetative lesion on the lips

Abstract

A 44-year-old female Indian patient reported with a slowly enlarging lesion on the lips for the preceding 2 months. The lesion had started as a few small fluid- and pus-filled lesions on the lower lip on the right side and then slowly spread to involve the entire upper and lower lips. The lesion did not cause any physical distress, but she was concerned because of its unesthetic appearance. She also gave a history of recurrent oral ulceration in the mouth for the previous 2 years. The ulcers would subside with topical steroids (prescribed by her general physician) in a few weeks. The ulcers would normally appear on the buccal and labial mucosa. She complained of burning sensation in the oral cavity on eating hot and spicy food. She gave a history of dryness of nasal mucosa with occasional epistaxis. There was no history of febrile illness, skin lesions, or genital or ocular lesions. She was not under medication for any systemic disease. She gave a vague history of abdominal discomfort with flatulence, constipation, and hyperacidity. She also gave a history of burning micturition and burning sensation in the genitourinary tract for the preceding 2 weeks. On extraoral examination, the vermilion areas of the lips showed vegetative plaques with inflammatory borders and miliary pustules at the periphery. The central areas appeared fissured and cracked, with slight bleeding on manipulation and crustations on the surface. The patient was constantly licking and wetting her lips with saliva to moisten their surface. The lesion involved the angular areas of the lips and stopped just short of the cutaneous border of the lip (Figure 1). Bilateral submandibular lymph nodes were palpable and tender. Intraoral examination showed white adherent plaques in association with erosive areas in the right and left buccal mucosa (Figure 2) and upper and lower labial mucosa (Figure 3). These lesions were also seen to involve the attached gingiva in the anterior maxillary and mandibular region. No intraoral vesicles, bullae, or pustules were seen. Nikolsky sign was not present. The tongue appeared fissured with lobulated surface. A chest radiograph, orthopantomogram and paranasal sinus radiograms did not show any abnormalities. Fig. 2Erosive lesions on the buccal mucosa. View Large Image Figure Viewer Fig. 3Erosive and vegetative lesions on the labial mucosa. View Large Image Figure Viewer