Approach

Table 1.1 Diagnostic and therapeutic approach I. Diagnosis • Complete history and physical examination • Evaluation of oral lesions • Examination and evaluation of skin and mucosal lesions elsewhere in the body • Evaluation of symptoms and signs in other systems • Intake of medications prior tD the beginning of the disease • Grouping of disease entities according to clinical criteria • Reevaluation of symptoms and signs in cases where the diagnosis is doubtful • Consultation with the family physician if necessary • Performance of biopsy on the basis of clinical indications • Histopathologic examination by an experienced pathologist • Evaluation of pathology report by the clinician, in relation to the symptoms and signs of the patient • Repeat biopsy if in doubt • Further laboratory evaluation if clinically indicated • Is the diagnosis correct • Reevaluation of the patient after initiation of therapy II. Differential diagnosis • Initiation of symptoms and signs • Duration (acute-subacute-chronic course) • General symptoms (fever, pain, malaise, anorexia, weight loss, arthralgias) • Lesion morphology (macules, papules, blisters, bullae, pustules, plaques, nodules) • Color of the lesions (white, red, black, brown, yellow) • Location (tongue, buccal mucosa, palate, floor of the mouth, gingiva, lips) • Coexisting skin lesions, mucosal lesions • Biopsy and histopathologic examination • Laboratory work-up (microbiology, immunology, hematology, imaging studies, molecular studies) Ill. Therapy • Choice of the right medication • Administration of the medication in the right form (pills, injections, ointments) • Exact dosage and dosage schedule • Consideration of clinical pharmacology issues, such as interaction between the administered drug and other medications that the patient is taking • Extreme care concerning contraindications for the drug that we intend to administer • Side effects due to our therapy • Adherence to the therapeutic program • Evaluation of the therapeutic result 2-4 days after initiation of therapy • In case of therapeutic failure, reevaluation of the diagnostic hypothesis • It is a general principle that correct therapy presupposes correct diagnosis