21. Non-Infectious Stomatitis Flashcards
What is characteristic of non-infective stomatitis?
- Recurrent Apthous Stomatitis (RAS) - “canker sores,” apthous ulcers occur in about 20-50% of population, from trauma or stress,
- T-cell mediated, HLA antigens have been associated, indicating a possible genetic predisposition. Diagnosis - clinical presentation and exclusion of other diseases.
- Tx: Topical steroids (Dexamethasone elixir -shouldn’t swallow, Fluocinonide), CHX, Amlexanox.
Minor apthae: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis-recurrent apthous stomatitis)
- 80% - being to develop in childhood, more in females, prodromal symptoms of burning, itching, less than 1.5cm, painful tan ulcers with erythematous borders,
- almost exclusively on moveable mucosa, most often occur on buccal and labial mucosa.
- Heal spontaneously in 7-14 days without scarring.
Major apthae: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis-recurrent apthous stomatitis)
- 10% - “Sutton’s Disease”
- onset in adolescence, 1.5-3+cm, deeper than minor apthae,
- Most commonly affects soft palate, tonsillar fauces or pharyngeal mucosa, Can take 2-6 weeks to heal, may cause scarring, recurrent episodes.
Herpetiform apthae: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis-recurrent apthous stomatitis)
10% - 1-3mm ulcers occuring in clusters, onset in adulthood, females, resemble uclers caused by herpes simplex, no systemic signs or symptoms, heal in 7-10 days.
Pseudo apthae: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis-recurrent apthous stomatitis)
- Associated with systemic diseases - GI malabsorption (Crohn’s),
- Vitamin deficiencies - iron, folate, B1, 2,6,12.
- Behcet’s Syndrome - chronic recurrent disease resulting from a systemic vasculitis. Oral 99%, ocular 70-85%, genital 75%, and systemic involvement.
- Oral lesions - similar to apthous ulcers, 6 or more, soft palate/oropharynx, ragged borders and variation in size. Pustules on skin of trunk and limbs with genital and corneal ucleration. 10-25% shows CNS involvement.
- Tx: Systemic/topical steroids, CHX
Lichen planus: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
- Named for it’s appearance to the plant lichen (moss). Uknown cause - but pathogenesis is immune mediated through T-cells, slight association with Hepatitis C.
- Middle aged adults, Skin - purple, pruritic, polygonal papules. Oral - reticular/erosive/bullous/plaque-like appearance.
- Most common type is reticular characterized by Wickham’s Striae. Most common cause of desquamative gingivitis (LP, pemphigus vulgaris, pemphigoid, allergy). Saw-toothed rete ridges with destruciton of basal cell histology, systemic drugs, hypersensitivity reactions (cinnamon,amalgam) epithlial dysplasia.
- Tx: Fluocinonide, Clobetasol (topical steroids).
What are the appearance of Pemphigus and which is most common?
Vulgaris (most common), Vegetans, Erythematous, Foliaceus
Pemphigus: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
- Severe progressive autoimmune disease that affects the skin and mucous membranes: oral lesions are usually first to appear. 40s-50s. Desmosomes,
- Painful superficial erosion and ulcerations, Affects most mucosal surfaces but often affects gingiva producing chronic desquamative gingivitis.
- Can induce epithelial separation by manipulating tissue or producing lateral pressure (+ Nikolski sign). Dx: Suprabasilar epithelial separation with acantholysis. Direct immunofluorescence show antibodies (IgG and C3) around keratinocytes.
- Tx: systemic steroids.
What is Benign mucous membran pemphigoid?
- A chronic autoimmude disease where patients produce antibodies against the structural proteins in their hemidesmosomes which anchor the basal keratinocytes to the underlying connective tissues.
- And it is a family of related disorders where antibodies are not directed against a single antigen, but many different antigens that compromise the hemidesmosomes.
Benign mucous membrane pemphigoid: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
- 50-60 years old, 3x more common in females, more common than pemphigus vulgaris, affects oral, ocular and genital mucosa.
- Ocular scarring can progress to blindness if untreated. Tissue desquamation produces erosion and ulcers.
- Most commonly affected site is gingiva.
- Tx: Opthalmologic consultation, topical or systemic steroids.
What can Desquamative Gingivitis be a clinical manefestation of?
- Lichen planus
- Pemphigus vulgaris
- Mucous membrane pemphigoid
- Allergic reaction (toothpaste, cinnamon, preservatives).
Erythema multiforme: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
- An acute onset, immude mediated blistering mucocutaneous condition. Most often following systemic medications or often post-infectious process, esp post-viral. Self-limiting 2-6 weeks, Affects skin and mucous membranes, rarely only the mouth. 20s-30s,
- MEN MORE AFFECTED, often follows a bacterial or viral infection or drug exposure. Prodromal - fever, malaise, headache, cough, sour throat, 20% recurrence rate.
What are some of the appearances of Erythema Multiforme?
- Skin - multiforme, “bulls-eye” lesion, palms and soles.
- Mucosa - oral ulcers with red irregular borders, lips, labial mucosa, tongue, FOM, soft palate, crusting and bleeding at vermillion zones of lips.
- Steven-Johnson Syndrome - more severe, extensive mucosal ulceration, genital mucosal ulceration, triggered by meds, can affect internal organs and life threatening. T
- oxic Epidermal Necrolysis - most severe form! triggered by drug exposure, females, diffuse sloughing of skin and mucosa.
Geographic tongue: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
- “Erythema Migrans, Benign Migratory Glossitis”
- inflammatory tongue condition of unknown etiology. 2x more common in females, dorsal and lateral borders of tongue,
- Depapillated areas that are erythematous or normal colored, with the characteristic yellow-white borders that marginate the lesions. Heal spontaneously. Inreased incidence in psoriatic patients.
- Reiters Syndrome - rare. Oral lesions look like geographic tongue.
Lupus erythematosus: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
- Autoimmune disease. 8x more common in women, avg age 31, classic “butterfly rash”
- Discoid LE - lesions confined to skin.
- Systemic LE - chronic and progressive - can be life threatening and affect organs - CNS, heart, kidney.
- Lab tests include ANA and antibodies to pt’s own DNA. Corticosteroids, anti-malarial drugs (hydroxylchloroquine), aspirin, NSAIDS.
