The oral cavity serves as a gateway to the digestive system, with its mucous membrane reflecting the general health of an individual. It is a specialized part of the skin, shares structural and embryological similarities with it. It often mirrors an individual’s overall health, with certain systemic diseases manifesting initially or exclusively in the oral cavity. This underscores the importance of examining the oral mucosa during a skin evaluation. Oral mucosal conditions and diseases can arise from various dermatological conditions, such as infections, autoimmune disorders, dermatitis, drug reactions, and sexually transmitted diseases, frequently involve the oral cavity. Lesions may present as erythematous patches, keratoses, ulcers, erosions, desquamation, vesicles, or bullae1.Despite this, studies on the prevalence of oral lesions among dermatology patients remain limited. Understanding this prevalence could highlight the importance of oral examinations across specialties, aiding in accurate and timely diagnoses. These conditions can lead to discomfort or pain, affecting essential functions like mastication, swallowing, and speech. They may also cause symptoms like halitosis, xerostomia, or oral dysesthesia, which can disrupt daily social activities2.  Oral diseases present in diverse forms, such as swelling (benign or malignant) or mucosal ulcerative lesions (premalignant or malignant), necessitating a thorough understanding of all pathological conditions for effective treatment and management. A premalignant lesion can be likened to a smoldering volcano that, if neglected, may erupt with catastrophic consequences. Oral cancer ranks as the sixth most common cancer globally3-5. It poses a significant health challenge, particularly in developing countries, where it is a leading cause of mortality. While oral cancers account for 2–4% of malignancies in Western countries, they represent nearly 40% of all cancers in the Indian subcontinent 3. 

AIM

Clinical study of oral mucosal lesions in patients attending dermatology outpatient department in a tertiary care centre 

This prospective observational study was conducted among patients attending the Derma OPD at Government medical College sri ganganagar between July 2023 and nov 2023. Patients were recruited through convenience sampling, and all individuals visiting the OPD during the study period were examined for oral mucosal lesions.  Patients attending the DVL OPD with specific oral lesions were included in the study.  Patients with restricted mouth opening and those with staining of teeth and mucosa were excluded.  All consecutive patients meeting the inclusion and exclusion criteria were included in the study. Written informed consent was obtained from all participants willing to join the study. A comprehensive history regarding the onset, type, and characteristics of the lesions was documented, followed by detailed clinical and systemic examinations. The diagnosis was established based on clinical history and examination. Additionally, clinical photographs of the lesions were taken after obtaining informed consent.

Table 1: Gender Distribution of Study Participants

R56% male (28 patients) and 44% female (22 patients) participants.

Table 2: Lifestyle Factors Contributing to Oral Lesions

10% of patients used tobacco,30% smoking and 40% chewed betel nut as lifestyle factors.

Table 3: Predisposing Factors for Oral Lesions

20% of patients with oral lesions had diabetes mellitus, while 6% had HIV as predisposing factors.

Table 4: Distribution of individual oral mucosal lesions in the study participants

Table shows that oral candidiasis (20%), mucosal vitiligo (16%), oral lichen planus (14%), aphthous ulcers (10%), herpes labialis and pemphigus vulgaris (8%), actinic and angular cheilitis (6%), systemic lupus erythematosus and glossitis (4%), and toxic epidermal necrolysis and leukoplakia (2%) were the most common oral mucosal lesions.

Table 5: Prevalence of Dermatological Diseases with Oral Manifestations

Table shows that 38% of patients had lichen planus, 22% had vitiligo, 14% had pemphigus vulgaris, 12% had systemic lupus erythematosus (SLE), 10% had toxic epidermal necrolysis, and 4% had dystrophic epidermolysis bullosa.

 Table 6: Prevalence of Combined Oral Lesions in the Study Population

Table shows 46% of patients had angular cheilitis with atrophic glossitis, 15% had leukokeratosis with angular cheilitis and Behçet’s disease with oral candidiasis, and 8% had combinations including oral pemphigus with oral candidiasis, angular cheilitis with glossitis and herpes labialis, and oral candidiasis with glossitis.

Oral mucosal lesions, beyond serving as clinical indicators of systemic illnesses, can manifest as components of various skin disorders with infectious, autoimmune, inflammatory, or drug-induced origins. Early screening and recognition of these lesions are crucial for accurate diagnosis and effective treatment.

In our study the population consisted of 28 male patients (56%) and 22 female patients (44%). This gender distribution highlights the male predominance in the sample. Our results were similar to the studies done by Babu et al and Ram et al which showed male to female ratio of 1:0.83 and 1:0.86 respectively 1,6.

In our study participants, 10% (5 patients) reported tobacco use, 30 %( 15 patients) engaged in smoking while a larger proportion, 40% (20 patients), engaged in betel nut chewing. These lifestyle factors are important considerations in the context of oral health. Similarly, according to a study done by Shivkumar et al, the history of tobacco use was 24% which is similar to our study3. In a study done by Mishra et al, the history of smoking was 34.7% and the history of chewing betel nut was 18.1% which is almost analogous to our study7. However our results were not comparable with a study done by Ali et al in which 70.1% of patients had a history of smoking8.

In our study, 10 out of 50 patients with oral candidiasis have predisposing factor of HIV and diabetes.20% (10 patients) of those with oral lesions had diabetes mellitus as a predisposing factor, while 6% (3 patients) had human immunodeficiency virus (HIV) as a contributing factor. These underlying conditions play a significant role in the development of oral health issues. Similarly Belazi et al found the frequency of oral candidiasis in patients with diabetes mellitus to be 13.7 to 64% which was consistent with our study9.

In the study, oral mucosal lesions were observed in various forms. Oral candidiasis was the most common, affecting 20% (10 patients), followed by mucosal vitiligo in 16% (8 patients) and oral lichen planus in 14% (7 patients). Aphthous ulcers were seen in 10% (5 patients), while herpes labialis and pemphigus vulgaris each affected 8% (4 patients) of the population. Actinic cheilitis and angular cheilitis were noted in 6% (3 patients) each, and systemic lupus erythematosus and glossitis were observed in 4% (2 patients) each. Less frequently, toxic epidermal necrolysis and leukoplakia were identified in 2% (1 patient) each. Similarly, According to a study done by Roy et al, among those with mucosal lesions, oral candidiasis was seen in 16.07% and oral LP in 12.77%4. These findings are consistent with our study. Keswani et al found aphthous ulcer to be the most common oral lesion comprising 31.4% of patients examined for oral lesions10.

Our study revealed that lichen planus was the most common disease, affecting 38% (19 patients) of the participants, followed by vitiligo in 22% (11 patients). Pemphigus vulgaris was observed in 14% (7 patients), while systemic lupus erythematosus (SLE) affected 12% (6 patients). Toxic epidermal necrolysis was present in 10% (5 patients), and dystrophic epidermolysis bullosa was found in 4% (2 patients).

Shivkumar et al found the most common dermatological diseases among those with oral lesions to be psoriasis and fungal infections each 20.6% which is varying with the results of our study3.

In our study, Out of 50 patients 13 have several combinations of oral lesions were observed. The most common was angular cheilitis with atrophic glossitis, affecting 46% (6 patients) of the participants. Leukokeratosis with angular cheilitis and Behçet’s disease with oral candidiasis each accounted for 15% (2 patients) of the cases. Other combinations included oral pemphigus with oral candidiasis, angular cheilitis with glossitis and herpes labialis, and oral candidiasis with glossitis, each representing 8% (1 patient) of the population.

Oral mucosal lesions serve as vital indicators of systemic and dermatological diseases, influenced by lifestyle factors like tobacco and betel nut use. In our study, oral candidiasis was the most common lesion, with diabetes and HIV as key predisposing factors. Early recognition and intervention remain crucial for effective management and improved outcomes. The oral cavity often remains an under examined area during routine outpatient evaluations, despite its potential to reveal critical diagnostic clues. Evidence suggests that oral manifestations can serve as early or even sole indicators of various dermatological conditions and systemic diseases. Understanding the prevalence and clinical significance of oral mucosal lesions can highlight the importance of incorporating thorough oral examinations into routine clinical practice, encouraging timely identification and management of underlying conditions

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