5 dermatologic diseases Flashcards
is desquamative gingivitis a diagnosis?
no, it is a clinical term to describe a manifestation of what is usually lichen planus, mucous membrane pemphigoid, or pemphigus vulgaris
clinical features of desquamative gingivitis
- female predilection
- diffuse, erythematous gingiva
- involves attached tissues
- sensitive to spicy food
- may or may not be symptomatic
what is the most common lichenoid process condition we will see
idiopathic lichen planus
clinical features of lichen planus
- purple, polygonal, pruiritic papules, very itchy
- flexor surfaces of extremities like wrists and shins
reticular form of lichen planus
- more common than erosive or ulcerative
- asymptomatic
- posterior buccal mucosa
- lacy white striations (wickham striae)
lacy white striations (wickham striae)
reticular form of lichen planus
-spiderweb like
lichen planus is usually bilateral or unilateral?*
bilateral
lichen planus most common form
reticular form
erthematous form of lichen planus
- symptomatic
- striae at periphery of erythema
- may cause desquamative gingivitis (must be distinguished from MMP or pemphigus)
striae at periphery of erythema
erythematous form of lichen planus
least common form of lichen planus
ulcerative form
ulcerative form of lichen planus
- symptomatic
- white lesions, red lesions, + yellow lesions
- ulcers with striae and erythema
- may cause desquamative gingivitis (must be distinguished from MMP or pemphigus)
lichen planus is
idiopathic, don’t know why patients get them
lichen planus associated with what common medications
- NSAIDS
- anti-hypertensives
- antihyperglycemics
- cholesteral lowering agents
- anti-hypothyroidism agents
- antigout medications
- amalgam restorations
- cinnamon flavoring agents
- herbal remedies
what is the exception to the rule that lichen planus is never unilateral
amalgam restorations or cinnamon flavoring if they only chew on one side of the mouth
Is lichen planus immune mediated?
yes, but not autoimmune bc it’s a T cell process
histopathologic features of lichen planus
- orthokeratosis/parakeratosis that causes white wickam striae
- saw tooth rete ridges
- degeneration of basal cell layer
- colloid bodies (Degenerative aptotic cells
- band-like inflitrate of lymphocytes
easiest feature to recognize of lichen planus
squamitization of basal cell layer or bandlike infiltrate of lymphocytes
treatment of lichen planus
- just observe if asymptomatic (don’t have to treat)
- topical corticosteroids
topical corticosteroids for treating lichen planus
- fluocinonide or clobetasol gel (warn patient they should eat/drink for 30 min for longer contact time)
- dexamethasone elixir
- prophylactic antifungals in patients predisposed to candidiasis
malignant prognosis of lichen planus
- needs life long follow up
- 1-2 % increased risk of developing SCCA
- reported cases associated with erosive form
lichen planus
wrist as purple polygonal papules, has fine white lines (Wickham’s striae)
erosive lichen planus
ulceratoin of buccal mucosa shows peripheral radiating keratotic striae
erosive planus often appears as
desquamative gingivitis, producing erythema + tenderness