title: Patterns of oral mucosa lesions in patients with epidermolysis bullosa: comparison and agreement between oral medicine and dermatology.
abstract: BACKGROUND
  The oral mucosa in patients with epidermolysis bullosa (EB) can be affected with different lesions and degrees of severity. However, patterns of oral lesions in distinct types of EB are still unclear.
  
  
  OBJECTIVE
  The purpose of this study was to determine the frequency and distribution of four types of lesions (erythema, erosion, atrophy, and blister) for each oral site and to calculate the interobserver reliability for each type of lesion in each site.
  
  
  METHODS
  Ninety-two patients with different EB types were assessed independently by an oral medicine specialist and a dermatologist. The degree of agreement was calculated by the intraclass correlation coefficient (ICC).
  
  
  RESULTS
  The most affected oral site was the tongue, with the most frequent lesion being erythema and atrophy [54(58.7%) patients] for the oral medicine specialist and erosion [54(58.7%) patients] for the dermatologist. Patients with recessive dystrophic EB-severe generalized (RDEB-sev gen) showed the highest mean of sites involved by each lesion for both oral medicine and dermatology. The interobserver reliability on the total of lesions was excellent on only 3 sites: lower lip (ICC: 0.89; 95%CI:0.83-0.92), hard palate (ICC:0.85; 95%CI:0.72-0.91), and tongue (ICC:0.89; 95%CI:0.84-0.92), whereas the interobserver reliability calculated for each single oral lesion showed a lower agreement.
  
  
  CONCLUSIONS
  Total distribution of sites involved by four types of lesions was higher in RDEB-sev gen than in the rest of EB types, with a predominance of erythema followed by erosion. The agreement on the type of lesion was found to be poor-moderate for many oral sites.
authors.affiliation: Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA; D.eb.RA. Mexico Foundation, Monterrey, Nuevo Leon, Mexico.
authors.forename: Giulio
authors.initials: G
authors.lastname: Fortuna
authors.forename: Francina
authors.initials: F
authors.lastname: Lozada-Nur
authors.forename: Annamaria
authors.initials: A
authors.lastname: Pollio
authors.forename: Massimo
authors.initials: M
authors.lastname: Aria
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Cepeda-Valdes
authors.forename: Matt Peter
authors.initials: MP
authors.lastname: Marinkovich
authors.forename: Anna L
authors.initials: AL
authors.lastname: Bruckner
authors.forename: Julio Cesar
authors.initials: JC
authors.lastname: Salas-Alanís
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy; D001768:Blister / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003880:Dermatology; D004820:Epidermolysis Bullosa / Q000473:pathology*; D016108:Epidermolysis Bullosa Dystrophica / Q000473:pathology; D004890:Erythema / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008047:Lip Diseases / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000473:pathology*; D009061:Mouth Mucosa / Q000473:pathology*; D015588:Observer Variation; D019242:Oral Medicine; D010159:Palate / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014060:Tongue Diseases / Q000473:pathology; D055815:Young Adult
keywords: bullous lesions; oral mucosa