Dimorphous lesions in oral cavity

Abstract

All leprosy forms may present oral mucosa lesions except for the indeterminate form. Those manifestations are rarely described in the literature, and when so, they refer to the lepromatous form of the disease. It is common to find a specific infiltrate with bacilli in biopsies of the palate of
lepromatous patients, even in the absence of evident clinical manifestation. Oral lesions are located on hard and smooth palate, pillar and tongue; the cheek mucosa and gums are free of lesions. In tuberculoid and borderline forms with chronic evolution there are no oral mucosa lesions and there are rare reactional cases described with histological lesions without clinical evidences, and there are even more rare cases with clinical oral lesions that do not resemble cutaneous lesions. The author present a patient with borderline reactional leprosy with an erythematous plaque on the hard palate extensive to the soft palate, identical to the lesion in the trunk and limbs. According to the authors lesions result from  ematogenic dissemination and they believe that even finding a certain amount of bacilli, this may not pose a risk of contamination because of the limited duration of the reactional episodes. The authors also believe there may be higher numbers of reactional patients with oral lesions because oral mucosa examination is rarely performed, even in lepromatous patients.