FIGURE 52.5 Strawberry tongue and cracked lips in Kawasaki disease Bleeding disorders such as thrombocytopenia or hemophilia may lead to intraoral petechiae, purpura, or ecchymosis These findings may also be due to intraoral trauma Particularly in young children, consideration of child abuse is warranted when intraoral injuries are identified Hereditary epidermolysis bullosa is a rare, vesiculobullous condition that affects mucous membranes and teeth, as well as skin Scarring may lead to restriction of mouth opening The painful cracking and erythema at the bilateral oral commissures known as angular cheilitis may be due to nutritional deficiencies of riboflavin, folate, or iron, or due to infections, allergies, physical irritation, or bruxism Treatment varies based on cause; antifungals may be helpful A spontaneous gingival abscess known as parulis may develop in children with vitamin D–resistant rickets; defects in tooth formation lead to bacterial invasion of the gingiva They present as fluctuant swelling; treatment is root canal therapy or tooth extraction Miscellaneous Oral Lesions Aphthous stomatitis is a painful, localized, self-limited ulceration of the oral epidermis of unknown cause Lesions typically present as 5- to 10-mm