Chronic ulcerative stomatitis (CUS): a new disease entity with specific immunological marker (SES-ANA)

A review of recently described cases with oral chronic erosive or ulcerative lesions associated with stratified epithelium specific antinuclear antibodies (SES-ANA) is presented. The lesions are refractory to local and systemic corticosteroids but may be responsive to hydroxychloroquine.     

Contact stomatitis

Contact stomatitis is inflammation or pain of the oral mucosa due to both irritant and allergic substances. Irritants include heat, frictional trauma, and chemicals. Oral flavorings, preservatives, and dental materials are common allergens. Simplification of oral care and avoidance of contactants is the primary mode of therapy. Patch testing to a broad series of antigens may be required to identify specific causes of allergic contact stomatitis.     

Contact stomatitis

Allergic contact stomatitis may be difficult to distinguish from irritant stomatitis and may mimic the oral changes of a vitamin deficiency, certain anemias, uremic stomatitis, stomatitis nicotina, and even candidiasis. When these conditions have been ruled out, skin patch testing may be indicated. There is no need to test the oral mucosa directly because the oral mucosa and skin are sensitized at the same time.     

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis is the most common ulcerative disease of the oral mucosa. The lesions of aphthous stomatitis are mucosal manifestations of a variety of conditions, 30 per cent of which may be discerned by history, physical examination, and appropriate laboratory testing. Correction of underlying conditions or deficiencies results in improvement or remission in aphthous disease activity. Treatment of lesions for which an underlying cause cannot be discerned is discussed.     

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis remains a commonly occurring cause of oral pain and ulceration. Although the ulcerations of RAS are multifactorial and of unknown cause, recognition of the role of patient and environmental factors may be helpful in developing recommendations for treatment and prevention of future ulcers.     

Characterization of an autoantigen associated with chronic ulcerative stomatitis: the CUSP autoantigen is a member of the p53 family.

A unique clinical syndrome has been described in which patients have chronic oral ulceration and autoantibodies to nuclei of stratified squamous epithelium. We have characterized the autoantibodies from patients sera and found that the major autoantigen is a 70 kDa epithelial nuclear protein. Sequencing of the cDNA for this protein, chronic ulcerative stomatitis protein, revealed it to be homologous to the p53 tumor suppressor and to the p73 putative tumor suppressor, and to be a splicing variant of the KET gene. The p53-like genes, p73 and the several KET splicing variants, are recently described genes of uncertain biologic and pathologic significance. This study provides the first clear association of a p53-like protein with a disease process.