Mechanical trauma to the oral lining can produce a variety of clinical lesions, depending upon the nature and circumstances of the insult. Three common red, flat lesions in the mouth are (1) the erythematous macule and erosion, (2) the purpuric macule, and (3) the granulomatous stage of the inflammatory hyperplasia. The erythematous lesions are previously described in "Common Traumatic Red Lesion, Part 1." This article discusses the second illness, the purpuric macules.

The purpuric macule is produced by a blunt traumatic insult to the skin or mucosa of sufficient force to cause the discharge of blood on the surface. If the sufferer is examined soon after the traumatic incident has occurred, petechial (small pinpoint) or ecchymotic (larger) areas are observed. These areas are quite red. If sufficient time has lapsed to permit some breakdown of the hemoglobin pigment, the "bruise" is bluish, undergoing the color changes from green to yellow.

The size of the purpuric macule varies according to the size and the force of the physical agent inflicting the damage. Usually the borders of the lesion are poorly demarcated, blending almost imperceptibly with the surrounding normal tissue. The lesion does not blanch on pressure because the red blood cells are within the tissues rather than in vessels. Nevertheless, purpuric macules may also have an accompanying inflammatory component. In such cases, you may see some blanching on palpation. Virtually any of the oral surfaces may be involved. The most common sites are the palate, the cheek, and the floor of the mouth.

Frequently, reddish elliptic purpuric macules occurring on the palatal skin near the junction between the hard and the soft part of the palate. This condition may be the result from oral sexual practices, when the repeated bumping of the male organ traumatizes on the soft tissue this region. In such a case the lesion disappears within 2 or 3 days, only to return again when the act is recur (Giansanti et al., 1975).

When the transient reddish macules are observed near the junction of the hard and soft palate, the following entities should be considered in your differential diagnosis. They are traumatic erythematous macule, purpuric macule, palatal bruising from severe coughing or vomiting, macular hemangioma, atrophic candidiasis, mononucleosis, and herpangina. The first four lesions are usually are painless. Hemangiomas seldom occur on the back of the palate, and both of the the erythematous macule and the hemangioma blanch somewhat on pressure. In contradistinction to the purpuric macule and the erthematous macule, the hemangioma is not transient.

If your lesion is diagnosed by your dentist or physician as a purpuric macule, you should be advised of its nature. You should be followed up at a later date to ensure that the diagnosis was correct and that the lesion has disappeared in a timely manner. In case where erythema (redness) is the main component, a smear for Candida albicans (yeast infection) should be performed (Damm et al., 1981). If candidal organisms are present in the smear, your dentist and physician may prescribe medications, such as nystatin or amphotericin, to institute therapy.

If several purpuric areas are present, you may be questioned if you have always bruised excessively and how extensive the trauma was. If the correlation is unsatisfactory, you may need to be tested for the presence of a bleeding diathesis.