Challenges in the management of oral manifestations in a patient with limited systemic sclerosis

Background: Limited systemic sclerosis (SSc), or scleroderma, is characterized by widespread vasculopathy, excessive multiorgan fibrosis, and autoantibody. The early stages of SSc are challenging to diagnose because of their similarity to other autoimmune conditions. Inappropriate SSc treatment can increase the risk of disability, morbidity, and mortality. Different pathogenesis pathways incur various manifestations in the skin and the oral cavity. In this scenario, dentists play an essential role in managing oral SSc manifestations. Proper oral examination, diagnosis, and therapy help to increase the confidence and patient’s quality of life. Case Report: A 24-year-old female patient with SSc was referred from the Internal Medicine Department to the Oral Medicine Department because of lip soreness for 2 weeks, resulting in difficulty eating and opening the mouth. A complete anamnesis and clinical examination were done. The patient was diagnosed with an oral ulcer caused by SSc, cheilitis exfoliative, drug-induced pigmentation, xerostomia, and acute pseudomembranous candidiasis. The oral lesion in this patient was concluded as an oral ulcer caused by SSc because the patient had already stopped using methotrexate for 2 weeks before the ulceration appeared. The oral treatment included sodium chloride (NaCl 0.9%), vaseline album, hyaluronic acid mouthwash, and nystatin. Oral lesions had a significant improvement after 3 days of treatment. Conclusion: The SSc manifestation that appeared on the oral cavity of the patient as microstomia, tongue stiffness, and oral ulcer resulted in inadequate clinical examination, and diagnosis. Treatments for this oral SSc were challenging.