Eosinophilic ulcer, also known as traumatic eosinophilic granuloma or traumatic ulcerative granuloma with stromal eosinophilia (TUGSE), is a rare inflammatory condition that affects the oral mucosa. It typically presents as a solitary, persistent ulcer or erosion with a raised, indurated border and a yellowish or whitish fibrinous surface. Eosinophilic ulcers most commonly occur on the tongue, lips, buccal mucosa (inner cheek), or palate, but can also affect other areas of the oral cavity.

Here are some key points about eosinophilic ulcer:

1. Etiology: The exact cause of eosinophilic ulcer is not fully understood, but it is believed to result from a localized immune response to trauma or injury to the oral mucosa. Traumatic factors such as chronic friction, biting, or irritation from dental appliances or sharp edges of teeth may trigger the development of eosinophilic ulcers. Allergic or hypersensitivity reactions may also play a role in some cases.
2. Pathogenesis: Eosinophilic ulcers are characterized by a dense infiltrate of eosinophils, a type of white blood cell involved in the body’s immune response to allergens and parasites. The presence of eosinophils within the ulcer’s stroma distinguishes eosinophilic ulcers from other types of oral ulcers. The exact mechanism underlying the recruitment of eosinophils to the ulcer site is not fully understood but may involve chemotactic factors released in response to tissue injury or inflammation.
3. Clinical Presentation: Eosinophilic ulcers typically present as solitary, well-demarcated ulcers or erosions with a raised, indurated (hardened) border and a yellowish or whitish fibrinous surface. The ulcers may vary in size and depth and are often painful or tender, particularly when irritated or traumatized. Eosinophilic ulcers may persist for weeks to months without healing and may recur in the same or different locations within the oral cavity.
4. Diagnosis: Diagnosis of eosinophilic ulcer is based on clinical examination and histopathological evaluation of a biopsy specimen. Histologically, eosinophilic ulcers are characterized by a dense infiltrate of eosinophils within the ulcer’s stroma, along with varying degrees of fibrosis, vascular proliferation, and ulceration of the overlying epithelium. Laboratory tests, such as blood tests or allergy testing, may be performed to rule out systemic conditions or allergic triggers associated with eosinophilic ulcers.
5. Treatment: Treatment of eosinophilic ulcers aims to alleviate symptoms, promote healing, and prevent recurrence. Management options may include topical corticosteroids to reduce inflammation and promote ulcer healing, topical anesthetics to relieve pain and discomfort, and avoidance of known irritants or allergens that may trigger ulcer formation. In some cases, systemic corticosteroids or other immunosuppressive medications may be prescribed for severe or refractory cases of eosinophilic ulcer.

In summary, eosinophilic ulcer is a rare inflammatory condition of the oral mucosa characterized by solitary, persistent ulcers with a raised, indurated border and a dense infiltrate of eosinophils within the ulcer’s stroma. While usually benign, eosinophilic ulcers can cause discomfort and may persist or recur without appropriate treatment. Early diagnosis and management are important for relieving symptoms and preventing complications associated with eosinophilic ulcer.