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305 > 18 - Oral Ulcers > Flashcards

18 - Oral Ulcers Flashcards

1
Q

What is aphthous stomatitis?

A

It is a recurrent aphthous ulcer or canker sore. It affects 20% of the population

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2
Q

What is the etiology of aphthous stomatitis?

A

It affects the T lymphocyte-mediated by the autoimmune condition.

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3
Q

How do we determine whether or not it is a erythroplakia or leukoplakia?

A

Through a biopsy.

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4
Q

How does aphthous stomatitis often start as?

A

Starts as an erythematous macule which develops into an ulcer. It is also covered with a fibrinous membrane

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5
Q

What are the 3 clinical presentations of aphthous stomatitis?

A

1.) Minor
2.) Major
3.) Herpetiform

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6
Q

How does an aphthous stomatitis present itself in the minor category?

A

1.) Single or multiple
2.) 3-10mm
3.) Heals in 7-10 days without scarring
4.) Non-keratinized tissue

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7
Q

How does an aphthous stomatitis present itself in the major category?

A

1.) Up to several centimeters
2.) Heal over several weeks (2-6 weeks), with scarring
3.) non-keratinized tissue

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8
Q

How does an aphthous stomatitis present itself in the herpetiform category?

A

1.) Clusters of hundreds of ulcers
2.) Not viral, despite name
3.) Heals in 7-10 days
4.) Small in size 1-3mm

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9
Q

In what type of mucosal surface do aphthous stomatitis usually present itself?

A

In the lining mucosa:
- lips
- soft palate
- cheeks
- oropharynx

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10
Q

What are some triggers to aphthous stomatitis?

A
  • Stress
  • Minor trauma
  • Genetics
  • Dietary triggers: gluten & milk proteins
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11
Q

What are the 2 diseases in which aphthous stomatitis can give rise to?

A

1.) Behcet’s disease
2.) Crohn’s disease (inflammatory bowel disease)

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12
Q

Where can Behcet’s disease typically present itself?

A
  • As an oral ulcer
  • genital ulcer
  • Eye lesion
  • skin lesion
  • positive pathergy
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13
Q

What are the criteria for Behcet’s disease?

A

If it has recurrent oral ulcerations + 2 of the following:

  • Recurrent genital ulcerations
  • eye lesions (uveitis)
  • skin lesions (erythema nodosum)
  • Positive “parthergy test”, interpreted by a physician
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14
Q

What is Behcet’s disease?

A
  • It is a systemic autoimmune disorder and is treated with systemic immunomodulatory medications
  • More common in people of eastern Mediterranean countries
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15
Q

What is Crohn’s disease?

A

It is an inflammatory bowel disease which often oral ulcers will parallel the insteinal manifestations

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16
Q

How is Crohn’s disease treated?

A

Treated with systemic immunomodulatories

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17
Q

What are the oral manifestations of Crohn’s disease?

A

1.) Aphthous stomatitis
2.) Healing and fibrosis: cobblestone appearance

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18
Q

How is Aphthous stomatitis managed?

A

1.) Rule out aforementioned systemic disease

2.) Rule out predisposing factors: test for micronutrient deficiencies

3.) Therapeutic intervention:
- pain control
- covering agents
- anti-inflammatory agents
- systemic immunomodulatory medications

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19
Q

What pain control management can trigger aphthous stomatitis

A

5% lidocaine ointment

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20
Q

What covering agent can trigger aphthous ulcers?

A

orabase and zilactin film

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21
Q

What anti-inflammatory agent can trigger aphthous ulcer?

A

Topical corticosteroids (mainstay of treatment)

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22
Q

What systemic immunomodulatory medication can trigger aphthous ulcers?

A

1.) Prednisone, thalidomide

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23
Q

What is lichen planus?

A

It is an immune ( T-lymphocyte) mediated condition. It is directed at an unknown antigen in the epithelium.

*typically limited to the mouth.

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24
Q

How is lichen planus characterized as?

A

By a pruritic (itchy, bumpy papule), papulosquamous rash, as well as oral lesions

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25
Q

In who does lichen planus affect the most?

A

More common in women. Prevalence of 0.1-2% of people

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26
Q

How does lichen planus present itself orally?

A
  • As a red and white tissue changes
  • typically found in the buccal mucosa
  • can be limited to the gingival tissues
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27
Q

What is Wickham’s striae in Lichen Planus?

A

It is the appearance of lacey, white striations.

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28
Q

What is desquamative gingitivitis?

A

It is the irritated, sloughing appearance of the gingival tissues (gingivitis-like)

29
Q

What are the 2 main forms of Lichen planus?

A

1.) Reticular Lichen planus (more benign)
2.) Erosive lichen planus (more soreness)

30
Q

What are the other forms of lichen planus?

A
  • papular
  • plaque-like
    -atrophic
  • bullous
31
Q

What are the other conditions that can result in lichen planus appearing lesions (lichenoid appearance)?

A

1.) Lichenoid drug reaction
2.) Lichenoid amalgam reaction
3.) Hepatitis C
4.) Graft-versus host disease
5.) Systemic lupus erythematosus

32
Q

What is the most common presentation of lichen planus?

A

Reticular Lichen Planus

33
Q

What are the characteristics of Reticular Lichen planus?

A
  • Characterized by Wickham’s striae
  • Generally asymptomatic
  • Rule out superimposed
34
Q

What does the histology of lichen planus appear like?

A

1.) Liquefactive degeneration
2.) Hyperkeratosis
3.) Saw-toothed reted ridge
4.) Subepithelial band of lymphocytes

35
Q

What are the treatments used for lichen planus?

A

1.) Rule out any possible causes (lichenoid drug reaction, contact sensitivity)
- NSAIDs are common cause of drug reaction

2.) Topical corticosteroids (maintaining good oral hygiene)

3.) Chlorhexidine. For superimposed infections

36
Q

What is the prognosis of lichen planus?

A
  • Chronic condition, no cure but is well-managed.
  • no symptoms = no tx required but follow-up is still needed
  • slight increase risk of oral cancer.
37
Q

What is pemphigus vulgaris?

A

It is a life-threatening autoimmune condition.
- It is due to Type II hypersensitivity attack against INTERCELLULAR connections

38
Q

Is more prone to having pemphigus vulgaris?

A

1.) Males/Females are equal
2.) 4th-6th decade
3.) Rare condition (1-2 in a million)

39
Q

What are characteristics of pemphigus vulgaris?

A

1.) Oral lesions are first to show, last to go.
2.) Has bullae (big blister appearance) on the skin & mucous membranes
3.) Hard to visualize oral vesicles, as they tend to break quickly
4.) Uncommonly affects the eyes, unlike mucous membrane pemphigoid

40
Q

What is Nikolsky’s sign?

A

It is a bulla that develops with shearing or pressing appearance.
It is a slight pressure of superficial mucosa that leads to sloughing and exfoliation

41
Q

How do we diagnose pemphigus vulgaris?

A

1.) 2 separate biopsies: first is a routine, the second is immunofluorescence
2.) Requires an immunofluorescence to help differentiate from other conditions

42
Q

What are some treatments for pemphigus vulgaris?

A

1.) Referral to the dermatologist
2.) Systemic medications required
3.) Prednisone and azathioprine are first line of defense

43
Q

What is the prognosis for pemphigus vulgaris?

A

1.) Poor without treatment (people can die if not treated properly)
2.) Fair with medications (have many side effects to the medication)

44
Q

What is mucous membrane pemphigoid?

A

It is known to be a cicatricial (tendency to cause scarring) pemphigoid. It is an autoimmune condition.

45
Q

What are the characteristics of Mucous Membrane pemphigoid?

A

1.) It is a type II hypersensitivity attack due to SUBEPITHELIAL conditions.
2.) Antibody-mediated
3.) Different from pemphigus vulgaris towards which conditions it affects

46
Q

Who is more likely to demonstrate symptoms of mucous membrane pemphigoid?

A

1.) Females>males
2.) 6th to 7th decade: older than pemphigus
3.) More common than pemphigus vulgaris

47
Q

What are some clinical features of Mucous membrane pemphigoid?

A

1.) Occular involvement
- blindness can develop
- 25% have ocular lesions

2.) Can involve other mucosal surfaces: genital surfaces

3.) Any oral surfaces

4.) Superficial erosion and sloughing of tissue

5.) Often erythematous

6.) May present gingival complications: desquamative gingitivitis

48
Q

Where can desquamative gingitivits be seen in?

A

1.) Lichen planus: most common
2.) MMP: 2nd most common
3.) Pemphigus vulgaris: least common

49
Q

What is the diagnosis of Mucous Membrane Pemphigoid?

A

1.) routine microscopy
2.) Immunofluorescence.

50
Q

Why is immunofluorescence used for mucous membrane pemphigoid ?

A

Because there are several other conditions that can present as an MMP. Immunofluorescence is required

51
Q

What are some treatments for mucous membrane pemphigoid?

A

1.) Topical corticosteroids (limit oral involvement)
2.) Referral to the ophthalmologist, to assess for ocular involvement

52
Q

What is the prognosis for mucous membrane pemphigoid?

A

1.) Prognosis: Fair, then pemphigus vugris
2.) Chronic condition
3.) Risk of blindness if not treated

53
Q

What is the difference between pemphigus vulgaris and mucous membrane pemphigoid?

A

The pemphigus vulgaris has an intraepithelial split, while the membranous membrane pemphigoid has a subepithelial split.

54
Q

What is the etiology of an erythema multiforme?

A

1.) Possibly from an allergic reaction

55
Q

What may trigger erythema multiforme?

A

1.) Herpes Simplex Virus
2.) Mycoplasma pneumonia

56
Q

What are the demographics of erythema multiforme?

A

Seen more in younger patients and males > females

57
Q

What are the two varieties of erythema multiforme?

A

EM Minor and EM Major

58
Q

What encompasses the Erythema Multiforme minor?

A

1.) It has a limited involvement
2.) 1 mucosal site

59
Q

What encompasses the Erythema Multiforme major?

A

Mainly involved with 2 or mucosal sites

60
Q

In what locations can we typically find Erythema Multiforme?

A

1.) In the lips (hemorrhagic crusting)
2.) Buccal mucosa
3.) Tagetoid lesions on the skin

61
Q

Erythema Multiforme has a ________ onset.

A

Sudden onset

62
Q

What association do oral lesions have with erythema multiforme?

A

1.) weight loss
2.) dehydration
3.) Difficulty eating and drinking

63
Q

What are the treatment and prognosis for erythema multiforme?

A

1.) Self-limited generally
2.) if due to HSV, consider prophylactic antivirals

64
Q

What is paraneoplastic pemphigus?

A

It is a pemphigus vulgaris appearing lesion induced by neoplasms.

65
Q

What are two examples of pemphigus vulgaris appearing lesions?

A

1.) Lymphomas
2.) Leukemia

  • patients with advanced cancers
66
Q

Why do paraneoplastic pemphigus lesions appear?

A

Due to the cross-reactivity of antibodies attacking cancer cells

67
Q

Who is most likely to show symptoms of paraneoplastic pemphigus ?

A

Older patients (rather than pemphigus vulgaris)

68
Q

What are the treatment options for paraneoplastic pemphigus?

A

Treat the underlying neoplasm

69
Q

What is the prognosis of paraneoplastic pemphigus?

A

Extremely poor (due to neoplasm nature of the lesion)

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