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Oral candidiasis > 12. Ulcerative lesions > Flashcards

12. Ulcerative lesions Flashcards

1
Q

What is an ulcer?

A

A break in the continuity of the skin or mucous membrane leaving an inflamed area of exposed connective tissue.
There is loss of the whole thickness of the epithelium.

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2
Q

What is an erosion?

A

More superficial- not all layers of the epithelium have been lost.
No exposure of the connective tissue.

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3
Q

How can ulcerations be divided?

A

Primary- de novo
Secndary to vesiculo-bullous diseases- vesicles rupture exposing the connective tissue

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4
Q

What is the definition of vesicle?

A

A collection of clear fluid within or just beneath the epithelium measuring up to 5mm in diameter.

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5
Q

What is the definition of bulla?

A

A collection of clear fluid within or just beneath the epithelium larger than 5mm in diameter.

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6
Q

What are mechanisms of ulcer formation?

A

Trauma
Ischaemia- eg, endarteritis obliterans
Altered cellular metabolism
GI disease
Cytopathic- viruses
Immunological
Neoplastic
Idiopathic

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7
Q

What do you do if a patient has traumatic ulceration?

A

Identify the cause- the cause must fit the size and shape of the ulcer
Removing the cause must show improvement in 10 days
If not, take a biopsy

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8
Q

How long does the epithelium take to regenerate itself, and the connective tissue?

A

Epithelium- 11 days
Connective tissue- 20 to 40 days

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9
Q

What is the histology of traumatic ulcer?

A

Non-specific chronic ulceration as you are exposing the connective tissue to all the pathogens in the mucosa.
Epithelium next to the ulcer may show increased number of mitoses.

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10
Q

What are the 6 types of trauma?

A

Mechanical
Chemical
Thermal
Irradiation
Factitious
Eosinophilic ulcer

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11
Q

What are examples of mechanical trauma?

A

Denture irritation
Biting
Sharp teeth
Toothbrush injury
External irritant
Removing cotton rolls without wetting

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12
Q

What are examples of chemical trauma?

A

Irritants and caustic agents
Mouth washes
Antiseptics
Aspirin

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13
Q

How does radiation cause ulcer?

A

Radiation kills fast dividing cells so also the epithelium. The epithelium becomes so thin that it may become atrophic.

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14
Q

What is factitious cause of ulceration?

A

Stress
Anxiety
Hypochondria
Malingering
Munchhausen syndrome

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15
Q

What is an eosinophilic ulcer?

A

Normally occurs in the tongue, very large ulcers that do not heal very quickly. Happens when the muscle becomes traumatised.
Full of eosinophils and histiocytes which are CD68 positive.

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16
Q

Which disease is eosinophilic ulcer found in?

A

Riga Fede disease in infants- the children have premature teeth and the ventral surface of the tongue rubs over them and gets ulcers

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17
Q

What is the histology of traumatic ulceration?

A

Break in the epithelium
Large amount of chronic inflammatory tissue- plasma cells, macrophages, lymphocytes
Coagulated formation of granulation tissue
Formation of new blood vessels and endothelial cells

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18
Q

What are 4 bacterial infections that involve ulceration?

A

Acute ulcerative gingivitis
Tuberculosis
Syphilis
Actinomycosis

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19
Q

What are 3 fungal infections that cause ulceration?

A

Histoplasmosis
Blastomycosis
Candidosis

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20
Q

What are the 3 stages of syphilis and what do they involve?

A

Primary- chancre- small sore that appears where the bacteria first enters the body
Secondary- snail ulcers
Tertiary- gumma, syphilitic leukoplakia- syphilitic leukoplakia is a white lesion.
Gumma is inflammatory response of arteries. Can involve endarteritis obliterans.

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21
Q

What type of ulcer does a Tb ulcer create?

A

One with deep, undermined edges

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22
Q

What is the histology of TB ulcer?

A

Lack of epithelium
Inflammatory infiltration
TB granulomas- caseating
Giant cells with multiple nuclei in periphery
Epitheiloid cells
Lymphocytes

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23
Q

What are the 3 types of RAS?

A

Minor apthous ulcers
Major apthous ulcers
Herptiform ulcers

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24
Q

What is Behcet’s syndrome?

A

RAS plus 2 of the following:-
- skin lesions
- genital ulcers
- eye lesions- uveitis
- skin hypersensitivity to needle puncture- pathergy test

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25
Q

What are 3 examples of idiopathic ulceration?

A

RAS
Behcet’s syndrome
Erythema migrans

26
Q

What has Behcet’s got a strong genetic link to?

A

HLA-B51
Has silk road distribution

27
Q

What are clinical features of RAS?

A

Onset in childhood
Recurrent

28
Q

What does RAS ulcers look like?

A

Round or ovoid, yellow-greyish base, erythematous halo

29
Q

What are the prodromal symptoms of RAS?

A

Soreness
burning
prickling sensation
erythematous macules 1 to 2 days before ulceration

30
Q

What age do minor, major and herpetiform ulcers affect?

A

Minor- 10-19
Major- 10-19
Herpetiform- 20-29

31
Q

How many ulcers are seen in minor, major and herpetiform?

A

Minor- 1-5
Major- 1-10
Herpetiform- 10-100

32
Q

What is the size (mm) of minor, major and herpetiform ulcers?

A

Minor- less than 10mm
Major- larger than 10mm
Herpetiform- 1 to 2 coalescing

33
Q

How long do minor, major and herptiform ulcers last for?

A

Minor- 7-14 days
Major- more than 30 days
Herpetiform- 10-30 days

34
Q

Which sites do minor apthous ulcers affect most?

A

Lips, cheeks and tongue

35
Q

Which sites do major apthous ulcers affect most?

A

Lips, cheeks, tongue, palate, pharynx

36
Q

Which sites do herpetiform ulcers affect most?

A

Lips, tongue, cheeks, palate, pharynx, floor of mouth, gingiva

37
Q

What are 4 reasons that RAS may occur?

A

Trauma
Stress
Associated with smoking cessation- perhaps related to keratinisation changes which occur when you stop smoking
Hypersensitivity to S.Sanguinis- some epithelial cells may have antigens that react to the antibodies of S.sanguinis

38
Q

What disorders are RAS linked to?

A

Haemotological disorders- ferritin, folate and B12 deficiency
Gastrointestinal disorders- coeliac, Crohn’s and ulcerative colitis
Allergies- food allergies show increased levels of IgE

39
Q

What is the histology of RAS in the pre-ulcerative stage?

A

Predominantly lymphocytic infiltration in the lamina propria and some in the epithelium.

40
Q

What is the histology of RAS in the ulcerative stage?

A

Inflammatory infiltration, especially cytotoxic lymphocytes in the epithelium, ulceration.

41
Q

What is the CD4 to CD8 count in the pre-ulcerative, ulcerative and healing stage?

A

2:1
1:10
10:1

42
Q

What triggers the immune reaction in RAS?

A

Epithelial antigens triggering the reaction are unknown but are likely to be cross reacting streptococcal antigens.

43
Q

What is the histology of erythema migrans?

A

Neutrophil infiltration in the borders of lesion
Chronic infiltrate in the centre
Desquamation of epithelium
No association with candida

44
Q

What is primary ulceration in haematological disease due to?

A

Iron, folate and B12 deficiencies

45
Q

What is secondary ulceration in haematological disease due to?

A

Secondary to gastrointestinal disorder where even if b12, iron and folate are present in the diet, they cannot be absorbed.
Eg, ulcerative colitis, Crohn’s disease, coeliac disease

46
Q

What are reasons someone may be low in iron?

A

Poor nutritional diet
May have had chronic blood loss- menstrual, GI
Malaria

47
Q

What are oral features when someone has iron deficiency?

A

Glossitis
Sore mouth
Ulceration
Angular stomatitis
Burning mouth

48
Q

What is low folate due to?

A

Cannot store this so mostly due to nutritional deficiencies
Leads to anaemia

49
Q

What are oral features of low folate?

A

Sore mouth, ulceration, angular stomatitis

50
Q

What are causes of low B12?

A

Vegan diet
Malabsorption
Some drugs which interfere with its absorption such as neomycin and colchicine
Pernicious anaemia- autoimmune

51
Q

What are oral features of B12 deficiency?

A

Glossitis, ulceration, beefy red tongue (Hunter’s glossitis)

52
Q

What is ulcerative colitis?

A

Inflammatory bowel disease of the large intestine

53
Q

What are the general symptoms of ulcerative colitis?

A

Intestinal ulcers
Pseudopolyp formation
Anaemia
Increased risk of colon carcinoma by 30 times

54
Q

What are oral features of ulcerative colitis?

A

Chronic ulceration
Pyostomatitis vegetans- white or yellow pustules on erythematous base
Avoid NSAID

55
Q

What are oral features of Crohn’s disease?

A

cobblestone appearance of oral mucosa
polypoid tags
linear ulcers
RAU
swelling of lips and cheeks

56
Q

What is the cause of coeliac disease?

A

Genetic hypersensitivity to gluten’s gliadin in wheat, rye or barley leading to villous atrophy of jejunal mucosa, leading to malabsorption.

57
Q

What are oral features of coeliac disease?

A

4-20% have RAU. Removal of gluten improves ulceration and villi in gut.

58
Q

What are dermatological diseases that ulceration is associated with?

A

Lichen planus
Chronic lupus erythematous
Vesiculobullous diseases

59
Q

What is the histology of Lichen planus?

A

Hyperkeratosis
Irregular acanthosis- saw-tooth rete ridges
Band like lympho-histiocytic infiltrate
Liquefaction or degeneration of basal cell layer
Presence of civatte hyaline bodies

60
Q

What is the possible pathogenesis of lichen planus?

A

Damaged or modified keratinocytes
Altered keratinocyte antigenicity- HLA-DR
Ability to present antigens to T-lymphocytes
Induction of cell-mediated immune response
Differentiation of cytotoxic T-lymphocytes which causes basal cell damage
Cytokine release from Langerhans cells and keratinocytes

Oral candidiasis (18 decks)

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