9: Allergies/Immunologic Diseases Flashcards
Elevated painful fungivform papillae often red, white or yellow in color with unknown etiology resolving on their own
Transient Lingual papillitis
This is a common oral mucosal pathoses that is caused by different things in different people, characterized by a large ulcer on nonkeratinized mucosa
Aphthous ulcer/Aphthous stomatitis/recurrent aphthous ulcer (RAU)
Layman’s term for Recurrent Aphthous ulcer(RAU)
Canker sore
7 factors that can contribute to Recurrent Aphthous Ulcer (RAU)
Allergies, Genetics, Nutritional deficiency, Hematologic abnormalities, Hormones, Trauma, Stress
9 systemic disorders associated with Recurrent Aphthous Ulcer (RAU)
Bechet’s Syndrome (ocular/orogenital lesions), Celiac disease (Gluten sensitivity in Small intestine), Cyclic neutropenia (cyclic low neutrophils ~21 days), Nutritional deficiencies, IgA deficiency, Immunocompromised, IBD, Reiter’s Syndrome (inflammatory arthritis, conjunctivitis, urethritis/cervicitis), Sweet’s syndrome (febrile neutrophilic dermatosis)
3 Clinical variations of aphthous ulcer
Minor 80% Major 10%
Herpetiform 10%
Aphthous ulcer variation with fewest recurrences, shortest duration, 1-5 lesions buccal and labial mucosa, but very painful?
Minor aphthous
Longest duration aphthous ulcer taking 2-6 weeks to heal, 1-10 lesions, labial mucosa, soft palate, tonsillar fauces, may cause scaring?
Major Aphthous
Aphthous ulcer with the most frequent recurrence, greatest number of lesion, up to 100?
Herpetiform Aphthous ulcers
If see HerpetiformAphthous ulcer, what should be done with medical history?
review med history to rule out underlying systemic disorder
2 drugs to treat Herpetiform Aphthous ulcer?
topical corticosteroids
Injections of triamcinolone acetonide
Tx for all 3 Aphthous type ulcers?
steroids
Multisystem disorder with oral, genital, or ocular lesions, always having oral lesions at some point, looking like aphthous ulcers?
Behcet’s syndrome
What is required to diagnose Bechet’s Syndrome
Recurrent oral ulcers w/ two of the following: Recurrent genital ulcers
Eye lesions, Skin lesions, Positive pathergy
What is positive pathergy associated with Bechet’s Syndrome?
Skin reaction to the injection of sterile saline
Where do aphthous ulcers associated with Behcet’s Syndrome appear orally?
Soft palate and oropharynz
Tx for Bechet’s Syndrome aphthous ulcers?
Topical or intralesional corticosteroids or oral colchicines or dapsone
Multisystem granulomatous disorder of unknown etiology?
Sarcoidosis
What race is more affected by Sarcoidosis?
Blacks, 10-17 times more than whites
2 age range peaks for Sarcoidosis?
25-35, 45-65
What system is always involved in Sarcoidosis?
Lymph
Sarcoidosis lesions that appear frequently on the nose, ear, lips, and face that are chronic, violaceous (violet color), indurated?
Lupus pernio
Sarcoidosis lesions that are scattered, nonspecific tender erythematous nodules, frequently occurring on the lower legs?
Erythema nodosum
What causes Sarcoid lesions?
Noncaseating granulomas
2 syndromes associated with Sarcoidosis
Lofgren’s syndrome & Heerfordt’s syndrome
Character of Lofgren’s Syndrome (2)?
Erythema nodosum (sarcoid), Bilateral hilar lymphadenopathy (sarcoid), Arthralgia (joint pain)
Character of Heerfordt’s Syndrome (good board question) (5)?
Uveo-parotid fever, Parotid enlargement, Anterior uveitis (eye inflammation), Facial paralysis, and Fever
This is a trashcan disorder that is diagnosed by the exclusion of other disorders. It’s character is nonspecific granulomatous inflammation.
Orofacial granulomatosis
What 4 other granuloma diseases must be ruled out before diagnosing Orofacial Granulomatosis?
Sarcoidosis, Crohn’s disease (form of irritable disease), Fungus infection, Foreign body reaction
Orofacial granulomatosis + Facial paralysis + fissured tongue (board question)
Melkersson-Rosenthal Syndrome
Allergic reaction of the oral mucosa to the systemic administration of a medication?
Stomatitis medicamentosa
2 best things to do when person comes in with highly ulcerated mouth?
List of meds, when they started taking each one, and how long the ulcers have been there
Allergic contact stomatitis caused by what and is prevalent in which gender?
Diverse topical agents; Female predilection
Acute Allergic Contact stomatitis symptoms (3)?
Burning (Itching/stinging/tingling), Redness, Edema
Chronic Allergic Contact stomatitis symptoms (3)?
Erythematous, white/hyperkeratotic, erosions in affected zone
4 ways to treat Allergic Contact stomatitis?
Remove suspected allergen, antihistamine therapy, topical anesthetic (dyclonine HCl), topical corticosteroids (fluocinonide gel or
dexamethasone elixir)
Unique inflammatory skin disease that involves the circumoral area?
Perioral dermatitis
What exacerbates perioral dermatitis?
Topical corticosteroid application
Tx of perioral dermatitis?
Metronidazole
What is a risk of cinnamon flavoring?
Contact stomatitis on gingiva
What does cinnamon flavor induced contact stomatitis resemble?
Plasma cell gingivitis (irradescent red gingivitis)
When there is a hypersensitivity to a dental metal, what metal is it?
Mercury
Lichenoid lesion only in the area of a dental material?
Lichenoid contact stomatitis
Hypersensitivity reactions to dental metals disappear after how many days once metal is removed?
10-14 days
Most commonly affected sites for Lichenoid contact stomatitis?
Posterior buccal mucosa, ventral surface of lateral border of the tongue
Diffuse edematous swelling of the soft tissues that most commonly involves the subcutaneous and submucosal connective tissues but may affect the GI or respiratory tract, occasionally fatal?
Angioedema/Quincke’s disease
Most common cause of Angioedema
Mast cell degranulation causing histamine release
2 ways to treat angioedema?
PO antihistamine and IM Epinephrine
