Oral mucosal peeling

Sir, peeling of the oral mucosa is rarely encountered in clinical practice and consequently it can cause diagnostic confusion for unfamiliar practitioners. Therefore, we would like to share an interesting case of oral mucosal peeling that we have recently encountered.

An 80-year-old Caucasian woman presented with a three-month history of asymptomatic peeling of her oral mucosa. The medical history was unremarkable and there was no history of mechanical and chemical trauma, nor any recent changes in her usual oral hygiene practices. Clinical examination showed only grey-white strips of oral epithelium sloughing from the buccal mucosae and dorsal tongue (Fig. 1, arrows). These epithelial layers sloughed spontaneously or could be peeled off easily leaving a normal tissue base with no bleeding or erosions. A clinical diagnosis of oral mucosal peeling (epitheliolysis) was made and the patient reassured and discharged.

Figure 1

Grey-white strips of oral epithelium sloughing from the buccal mucosae and dorsal tongue

Oral epitheliolysis (also known as shedding oral mucosa or oral mucosal peeling) is a rarely described and often unrecognised superficial desquamation of oral mucosa that may be caused by sodium lauryl sulphate (SLS) containing oral hygiene products, though some cases appear idiopathic. The condition has no significant clinical consequences and usually resolves spontaneously or upon discontinuation of any implicated toothpastes or mouthwashes.^1,2,3