Punctate oral erosions: Self-limited 'sore' - Or something more serious?

Viral and fungal infections, autoimmune conditions, immunodeficiency, drug reactions, contact allergy, and trauma all can precipitate punctate oral lesions. Herpetic lesions must be distinguished from aphthous ulcers, which lack a preliminary vesicular phase and have a more intense erythematous halo; herpetic lesions tend to occur in clusters and involve the fixed mucosa. Extremely large aphthous ulcers that persist for several weeks or months can mimic a carcinoma; biopsy is indicated. Because of their rarity in immunocompetent persons, fungal and cytomegalovirus infections in the oral cavity are clinical markers for AIDS. Drug-induced oral lesions can be diagnosed on the basis of the drug and medical history and a complete blood cell count; lesions usually appear when the white blood cell count falls below 2,000/μL. Eosinophilic ulcers are reactive lesions in the oral cavity that are deep and generally larger than 1.5 cm, with indurated borders; biopsy is essential to rule out carcinoma.