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CASE REPORT
Year : 2010  |  Volume : 55  |  Issue : 1  |  Page : 92-94
Riga-Fede-Like disease in a 70 year old woman


Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany

Date of Web Publication4-Mar-2010

Correspondence Address:
Uwe Wollina
Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstrasse 41, 01067 Dresden
Germany
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DOI: 10.4103/0019-5154.60361

PMID: 20418986

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   Abstract 

Riga-Fede disease (RFD) describes a benign, ulcerative lesion resulting from the repetitive trauma of contact of the oral mucosal surface of the tongue with the teeth. Although the name applies primarily to small children, similar clinical and histopathological findings can also be found in adults. We describe here a 70 year-old woman showing a painful tongue ulcer with elevated borders and whitish discoloration for the past four years. Repeated histological investigations revealed a benign leukoplakia without dysplasia. Replacement of an ill-fitting prosthesis led to complete remission within two weeks. RDF-like disease is thus a problem in elderly patients for whom topical treatment is insufficient to induce healing.


Keywords: Riga-Fede-disease, traumatic tongue ulcer, prosthesis


How to cite this article:
Wollina U. Riga-Fede-Like disease in a 70 year old woman. Indian J Dermatol 2010;55:92-4

How to cite this URL:
Wollina U. Riga-Fede-Like disease in a 70 year old woman. Indian J Dermatol [serial online] 2010 [cited 2014 Jul 24];55:92-4. Available from: http://www.e-ijd.org/text.asp?2010/55/1/92/60361



   Introduction Top


 Riga-Fede disease More Details (RFD) describes a benign, ulcerative "granulomatous" lesion resulting from the repetitive trauma of contact of the oral mucosal surface of the tongue with the teeth. This entity was first described in 1881 by the Italian physician, Antonio Riga, and as additional cases were subsequently published by F. Fede in 1890, it has been known as Riga-Fede disease. [1],[2] Although the name applies primarily to children, similar clinical and histopathological findings can also be found in adults. [3],[4] Although the lesions are microscopically identical, the causes of trauma differ in the adult population as they may be related to the presence of broken teeth or ill-fitting prosthetic material in the oral cavity. Early recognition of this entity is important because it may be the presenting sign of an underlying neurological disorder. [1]

This condition has rarely been described in elderly people, which is surprising as denture-related lesions account for 36.4% of the cases with the length of denture use and diabetes mellitus being significant risk factors for denture stomatitis and denture hyperplasia. [5]

A broad variety of terms have been used to describe RFD, such as eosinophilic ulcer of the oral mucosa, sublingual fibrogranuloma, sublingual growth in infants, lingual traumatic ulceration, traumatic atrophic glossitis, traumatic granuloma of the tongue, and traumatic ulcerative granuloma with stromal eosinophilia. [1],[2],[3],[4],[6],[7]

RFD-associated ulceration may remain for years and can result in long-lasting tongue deformity. [1],[2]


   Case Report Top


A 70 year-old woman presented with a painful ulcer with elevated borders and whitish discoloration. The lesion had been present for the past four years and had been biopsied twice. Histological investigations revealed a benign leukoplakia of the tongue without dysplasia. Treatment was done with topical corticosteroids but failed to induce complete remission. The patient had no other systemic medications.

The patient was subsequently referred to our outpatient department for further advice. Examination of the oral cavity revealed an ulceration of the left undersurface of the tongue [Figure 1] and showed close contact with an ill-fitting prosthesis of the mandibular molars [Figure 2]. There was no clinical sign of any neuropathy and the patient was advised not to use the prosthetics for two weeks and to come back to the department at the end of this period. Complete healing was observed at that time [Figure 3] and a relapse of the ulcer was noted after another week of use of the prosthesis.

A diagnosis of a chronic traumatic RFD-like tongue ulcer was confirmed and the patient was referred to her dentists to improve the fitting of her prosthesis.


   Discussion Top


Chronic ulcerations of the tongue are not uncommon in old age. The differential diagnoses include various benign and malignant conditions: Squamous cell carcinomatous ulcer, syphilis chancre, tuberculosis, malakoplakia, cytomegalovirus infection, fungal disease, major aphthous ulcer, Behcet's disease, mucous membrane pemphigoid, pyoderma gangraenosum, orofacial granulomatosis, graft-versus-host disease, ulcerating lichen planus mucosae, amyloidosis, autoaggression, midline granuloma, necrotizing sialometaplasia, lymphoma and leukemia. [1],[2],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19] Drugs, particularly chemotherapeutics and radiotherapy can cause chronic ulcerations of the tongue as well. Less well known is the development of chronic tongue ulcers in bisphosphonate-associated osteonecrosis of the jaws. [20] Hence, diagnosis must be based on histopathological findings and course of the disease.

Histological investigations show a chronic mucous ulceration surrounded by a dense infiltrate of lymphocytes, monocytes, and numerous eosinophils in RFD and RFD-like conditions, without any other findings related to infection or neoplasia. Although clinically described as a granulomatous process, no granuloma has been seen microscopically. [1],[2]

Treatment is aimed at minimizing the repetitive trauma and consists of behavior modification and dental extraction, filling of the teeth, or acrylic appliances placed over the broken teeth. [1],[2],[20] If ill-fitting prosthetic material is the cause of trauma, it has to be exchanged as in the presented case. Complete remission is achievable only when the provoking factors can be avoided.

 
   References Top

1.Zaenglein AL, Chang MW, Meehan SA, Axelrod FB, Orlow SJ. Extensive Riga-Fede disease of the lip and tongue. J Am Acad Dermatol 2002;47:445-7.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Baroni A, Capristo D, Rossiello L, Faccenda F, Satriano RA. Lingual traumatic ulceration (Riga-Fede disease). Int J Dermatol 2006;45:1096-7.  Back to cited text no. 2      
3.Ceyhan AM, Yildirim M, Basak PY, Akkaya VB, Ayata A. Traumatic lingual ulcer in a child: Riga-Fede disease. Clin Exp Dermatol 2008;34:186-8.  Back to cited text no. 3      
4.Cunha VS, Zanol JDR, Sprinz E. Riga-Fede-like disease in an AIDS patient. J Int Assoc Physicians AIDS Care (Chic Ill) 2007;6;273-4.  Back to cited text no. 4      
5.Dundar N, Ilhan Kal B. Oral mucosal conditions and risk factors among elderly in a Turkish school of dentistry. Gerontology 2007;53:165-72.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Ada S, Seckin D, Tarhan E, Buyuklu F, Cakmak O, Arikan U. Eosinophilic ulcer of the tongue. Australas J Dermatol 2007;48:248-50.  Back to cited text no. 6      
7.Segura S, Pujol RM. Eosinophilic ulcer of the oral mucosa: A distinct entity or a non-specific reactive pattern? Oral Dis 2008;14:287-95.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Al-Rawi NH, Talabani NG. Squamous cell carcinoma of the oral cavity: A case series analysis of clinical presentation and histological grading of 1,425 cases from Iraq. Clin Oral Investig 2008;12:15-8.   Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Scott CM, Flint SR. Oral syphilis-re-emergence of an old disease with oral manifestations. Int J Oral Maxillofac Surg 2005;34:58-63.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]  
10.Sriram G. Tuberculous ulcer of tongue with oral complications of oral antituberculous therapy. Indian J Dent Res 2006;17:202.  Back to cited text no. 10      
11.Hayes M, White D, Richards A. Secondary syphilis presenting as atypical oral ulceration-a case report. Dent Update 2008;35:465-7.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]  
12.Torres R, Cottrell D, Reebye UN. Ulcerative tongue lesion secondary to cytomegalovirus. J Mass Dent Soc 2004;53:36-7.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]  
13.Hegarty A, Hodgson T, Porter S. Thalidomide for the treatment of recalcitrant oral Crohn's disease and orofacial granulomatosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:576-85.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]  
14.Suresh L, Martinez Calixto LE, Radfar L. Successful treatment of mucous membrane pemphigoid with tacrolimus. Spec Care Dentist 2006;26:66-70.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]  
15.Park HJ, Han BG, Kim YC, Cinn YW. Recalcitrant oral pyoderma gangrenosum in a child responsive to cyclosporine. J Dermatol 2003;30:612-6.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]  
16.Argiriadou AS, Sardella A, Demarosi F, Carrassi A. Gingival lesions in a patient with chronic oral graft-versus-host disease: A case report. J Clin Periodontol 2003;30:375-8.  Back to cited text no. 16  [PUBMED]  [FULLTEXT]  
17.Koloktronis A, Chatzigiannis I, Paloukidou N. Oral involvement in a case of AA amyloidosis. Oral Dis 2003;9:269-72.  Back to cited text no. 17  [PUBMED]  [FULLTEXT]  
18.Gileva OS, Sazhina MV, Gileva ES, Efimov AV, Scully C. Spectrum of oral manifestations of HIV/AIDS in the Perm region (Russia) and identification of self-induced ulceronecrotic lingual lesions. Med Oral 2004;9:212-5.   Back to cited text no. 18  [PUBMED]  [FULLTEXT]  
19.Cho KJ, Cho SG, Lee DH. Natural killer t-cell lymphoma of the tongue. Ann Otol Rhinol Laryngol 2005;114:55-7.  Back to cited text no. 19  [PUBMED]  [FULLTEXT]  
20.Treister NS, Richardson P, Schlossman R, Miller K, Woo SB. Painful tongue ulcerations in patients with bisphosphonate-associated osteonecrosis of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:1-4.  Back to cited text no. 20      


    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 May iotaderma (#220)
Rudolph, R.I.
Journal of the American Academy of Dermatology. 2012; 66(6): e259
[Pubmed]



 

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