Acute and Chronic Ulcerative Lesions Part 2 Flashcards
Aphthous Stomatitis
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
“Canker Sores”
Category:
-Immune-mediated
Etiology:
-CD8+ T-cells produce TNF-alpha (inflammatory cytokine)
-Trigger is “different things in different people”
Demographics:
-More frequent in children and young adults
Clinical Presentation:
-Ulcer with yellow-white fibrinopurulent membrane, encircled by an erythematous halo
-Occur on nonkeratinized (moveable) mucosa
Diagnosis:
-Clinical
-Histopathology of an aphthous ulcer is not diagnostic
Tx:
-Heal w/o tx
-Topical steroid or steroid rinse for recurrent cases
-Laser ablation shortens duration and decreases symptoms, but may not be practical in all cases
List the types of Aphthous Stomatitis “Canker Sores”
- Minor Aphthous Ulcers
-Most common (80%)
-Experience fewer recurrences
-Shortens duration - Major Aphthous Ulcer
-Larger than minor aphthae
-Tend to be recurrent
-Take 2-6 weeks to heal
-Scarring can occur - Herpetiform Aphthous Ulcers
-Tend to have multiple ulcers, but each ulcer is smaller than minor aphthae
-Tend to be recurrent
-Heal in 7-10 days
List the reported causes of Aphthous Stomatitis “Canker Sores”
-Allergies
-Genetic predisposition
-Hematologic abnormalities
-Hormonal influences
-Immunologic factors
-Infectious agents
-Nutritional deficiencies
-Smoking cessation
-Stress (mental and physical)
-Trauma
List the associated systemic disorders of Recurrent Aphthous Stomatitis
-Behcet syndrome
-Celiac disease
-Cyclic neutropenia
-Crohn’s disease
-Ulcerative colitis
-Nutritional deficiencies
Allergic Contact Stomatitis
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category:
-Immune-mediated
Etiology:
-Allergy to food, food additive, chewing gum, candy, dentifrice, mouthwash, or dental materials
Demographics:
-More common in females
Clinical Presentation:
-Burning sensation
-Erythema with or without edema
-Superficial ulcerations may be present
-Rarely, vesicles are seen
Diagnosis:
-Temporal relationship between use of the agent and eruption
-Patch testing may be useful in identifying allergen
Tx:
-Removal of allergen
Erythema Multiforme
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category:
-Immune-mediated
Etiology:
-Triggered by infection –>
1. mycoplasma pneumonia
2. herpes simplex virus 1 (HSV-1)
-Triggered by medication –>
1. NSAIDs
2. Sulfonamides
3. Antiseizure medications
4. Antibiotics
Demographics:
-Average age range is 20-40 yrs old
Clinical Presentation:
-Diffuse oral ulcerations
-Hemorrhagic crusting of the lips
-Targetoid skin lesions
Diagnosis:
-Clinical history and presentation
-Bloodwork for Mycoplasma pneumonia and HSV-1 IgM antibodies
-Identification of drug
Tx:
-Self limiting (2-6 weeks)
Traumatic Ulcer
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category:
-Injury
Etiology:
-Some form of injury (biting, neighboring sharp tooth, puncture, etc.)
Demographics:
-Broad age range
Clinical Presentation:
-Area of erythema around a central yellow fibrinopurulent membrane
-May develop a rolled white border of hyperkeratosis adjacent to ulceration
-Most common on tongue, lips, and buccal mucosa
Diagnosis:
-If lesion persists beyond two weeks, biopsy to rule out squamous cell carcinoma
Tx:
-Remove source of trauma
-Heals with time
Syphilis
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category:
-Infectious
Etiology:
-Treponema pallidum
-Spread by direct contact with mucosal surfaces (sexual contact, mother to fetus)
-Three stages of disease (primary, secondary, tertiary)
-Patients are highly infectious during the first two stages
Demographics:
-Broad range
Clinical Presentation
-(see following cards - differs between primary, secondary and tertiary)
-Oral manifestations of syphilis can mimic many other conditions
Diagnosis:
-Biopsy
-Blood tests:
1. Venereal Disease Research Laboratory (VDRL)
2. Rapid Plasma Reagin (RPR)
3. Results can be negative for up to 6 weeks after initial infection
Tx:
-Antibiotics (Penicillin)
Describe the Clinical Presentation of Primary Syphilis
-Chancre
1. solitary, papular lesion with central ulceration
2. 85% genital, 4% oral
-Regional lymphadenopathy
-Symptoms resolve in a few days, even without tx
Describe the Clinical Presentation of Secondary Syphilis
-Occurs in 4-10 weeks after initial infection
-Systemic symptoms:
1. painless lymphadenopathy
2. sore throat
3. malaise
4. headache
5. weight loss
6. fever
-Diffuse maculopapular cutaneous rash
-Split papule (papule in the crease of the oral commissure)
-Mucous patch (whitish, elevated plaque –> frequently on tongue, lip, buccal mucosa, and palate)
Describe the Clinical Presentation of Tertiary Syphilis
-Gumma:
1. indurated, nodular, or ulcerated lesion
2. may cause extensive tissue destruction
3. usually affect palate or tongue
-Affects vascular system and CNS
-Can result in paralysis, psychosis, dementia, and death
Mucous Membrane Pemphigoid
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category:
-Immune-mediated
Etiology:
-Autoantibodies against hemidesmosomes and components of basement membrane
Demographics:
-Older adults (50-60 yrs)
Clinical Presentation:
-Vesicles or bullae
-Large areas of ulcerated/denuded mucosa
-Can be limited to gingiva (desquamative gingivitis)
-Can involve skin and conjuctival, nasal, esophageal, laryngeal, and vaginal mucosa
-Positive Nikolsky sign
Diagnosis:
-Two perilesional biopsies:
1. One in formalin (subepithelial clefting)
2. One in Miche’s solution for direct immunofluorescence (DIF) (linear band of immunoreactants at basement membrane zone)
Tx:
-Should be managed by a clinician experienced with treating the condition
-Varying combinations of topical and systemic therapy, usually including steroids and immunosuppressive agents
-Referral to ophthalmologist
What is a positive Nikolsky Sign?
-Firm lateral pressure on intact mucosa causes epithelial separation
-Seen in mucous membrane pemphigoid and pemphigus vulgaris
What is a possible side effect of Mucous Membrane Pemphigoid and what referral does it require?
-Symblepharon formation from conjunctival involvement can lead to blindness
-Must provide ophthalmology referral
Pemphigus Vulgaris
-Category
-Etiology
-Demographics
-Clinical Presentation
-Diagnosis
-Tx
Category:
-Immune-mediated
Etiology:
-Autoantibodies against components of desmosomes
Demographics:
-Middle-aged adults
Clinical Presentation:
-Ulceration of any oral mucosal surface (predilection for palate)
-May present with desquamative gingivitis
-May have skin involvement
-Positive Nikolsky sign
Diagnosis:
-Two perilesional biopsies:
1. One in formalin (intraepithelial cleft)
2. One in Michel’s solution for direct immunofluorescence (DIF) (Immunoreactants deposited in intercellular areas (chicken wire pattern)
Tx:
-Should be managed by a clinician experienced with treating the condition
-Varying combination of topical and systemic therapy, usually including steroids and immunosuppressive agents
