Body Parts Connected to the Skin Flashcards
How many telangiectasia on the body are considered to be pathological?
More than 5
If you see multiple Telangiectasia around the mouth, what condition should you consider?
Osler Weber Rendu
In what conditions do multiple telangiectasia appear?
- Liver disease
- Rheuamtoid Arthritis
- Pregnancy
- Various Drugs (COCP)
- Post Radiation
- Connective Tissue Disease (Systemic Sclerosis)
What are some viral causes of oral lesions?
-
Herpes Simplex 1 & 2 - grouped vesicles.
- Gingivostomatitis
- Chicken pox
- Measles - Koplik spots
- Coxsackie Viruses - mouth ulcers - herpangina
-
Hand Foot and Mouth - greyish mouth ulcers.
- fever, lymphadenopathy and malise
This child had a sore mouth, bad breath, pain on swallowing and swollen gums.
What is this?
Gingivostomatitis due to HSV
What is this?
Herpangina
Usually due to coxackie virus.
What are these?
Koplik Spots
What is this and what are some causes of it?
Cheilitis
- Atopic eczema
- Irritant dermatitis (usually from saliva)
- Contact dermatitis
- Nutritional deficiencies (especially Vit C and Zinc deficiency)
- Drug-induced cheilitis
- Angular cheilitis
- Actinic cheilitis
- Granulomatous cheilitis
- Trauma
In younger patients, what is the main cause of angular cheilitis?
Irritant contac with saliva or licking of lips
In older patients, what is the main cause of angular cheilitis?
Poorly fitting dentures.
If a patient has angular cheilitis, what should also be considered?
Secondary infection with Staph or candida.
What nutritional deficiencies can cause angular cheilitis?
Vitamin C and Zinc
(Most commonly caused by alcoholism and eating disorders)
What is the treatment for angular cheilitis?
- Mild to moderate topical steroid +/- antibiotic/ antifungal.
- Once resolved, give soft white paraffin to maintain control.
What are the 2 main causes of contact dermatitis on the lips?
- Agents put directly on the lips (lipstick, mouthwashes)
- Agents transferred to the lips fom the hands (e.g nail varnish)
What is this and what is the management for this?
Acitinic Cheilitis
- Ablative therapy -e.g. cryotherapy; curettage and cautery; shave cautery
- Topical agents -e.g. 5-fluorouracil (Efudix) or Imiquimod cream (Aldara)
- Daily use of a high factor sunscreen for the lips
What is this and what is the treatment?
SCC of the lip
Excision.
This patient has Granulomatous Cheilitis.
What diseases is it associated with?
What investigations should be done?
- Crohn’s disease
- Sarcoidosis
- Chronic Contact Dermatitis due to dental materials such as cinnamates.
Investigations
- Biopsy
- Chest X-Ray
- Bowel investigations for crohns
- Patch Testing.
What syndrome can granulomatous cheilitis be associated with?
Melkerson-Rosenthal Syndrome
- Tongue swelling (Scrotal tongue)
- Recurrent facial palsy
Usually idiopathic or associated with the aforementioned conditions on the other card.
What is the treatment for Granulomatous Cheilitis?
- Topical steroids (usually moderately potent is enough)
- Intralesional steroids (be careful of skin atrophy)
- Oral immunomodulatory drugs (rarely needed)
What is the treatment for an apthous ulcer?
- Hydrocortisone buccal tablets.
- Chlorhexidine mouthwash.
What rare conditions can cause oral ulcers to form?
- Behçet’s disease
- Drugs
- Irradiation
- Blistering disorders
- Systemic diseases (Crohn’s disease)
- Metabolic deficiency diseases (vitamin C deficiency i.e. scurvy, zinc deficiency)
- connective tissue disorders (e.g. SLE)
- HIV
- Other viral illnesses.
What is the treatment approach to apthous ulcers?
- Exclude systemic disease - 10% of Crohn’s patients have recurrent apthous ulcers.
- Exclude infection - herpes etc.
- Advice good oral hygeine
- Symptomatic treatment - hydrocortisone buccal tablets and chlorhexidine mouthwash.
What are the features of Behcet’s Syndrome?
Triad of:
- Recurrent oral ulcers
- Genital ulcers
- Uveitis
- Other features include: arthropathy, meningo-encephalitis, colitis, neuropathies, vasculitis.
What test is indicative of Behcet’s disease?
Pathergy test - pustules at the site of venepuncture.
What are the causes of Behcet’s Disease?
- It is generally not known.
- Genetic link to HLA B51
- Correlated with Streptococcal infection
- Considered an auto-inflammatory disorder.
What ethnic group is Behcet’s disease more common in?
Eastern Mediterranean and Middle Eastern.
What is the management of Behcet’s Disease?
- Apthous Ulcers - treat.
- Resistant disease - consider Prednisolone, Colchicine, Dapsone, Sulfasalazine.
Which of the two will affect the oral mucosa?
Bullous Pemphigoid or Pemphigus Vulgaris?
Pemphigus Vulgaris
What is this?
What malignancy is it associated with?
- Paraneoplastic pemphigus - severe and painful oral ulcerations of the lips and lateral borders of the tongue.
- Associated with B Cell Lymphoproliferative disorders.
What condition is this?
Oral Lichen Planus
What % of patients with generalised LP have intraoral LP?
1-2%
Oral Lichen Planus is usually a clinical diagnosis. But what can be done if you are unsure?
A biopsy
What is the treatment for oral lichen planus?
Same as aphthous ulcers.
What is a potential problem for people with oral lichen planus?
1-5% will develop oral LP
(It is more common with the erosive form)
What are some causes of gingival hyperplasia?
- Crohn’s disease
- Pregnancy
- Scurvy
- Drugs
- Phenytoin
- Cyclosporin
- Nifedipine
- Myeloma.
What is perifolicular hyperplasia associated with?
Scurvy
How is atopic or contact exczema of the eyelids treated?
- Mild topical steroids.
- Pimecrolimus or Tacrolimus can also be used.
What conditions cause thinnning of the eybrows?
- Hypothyroidism
- Foolicular mucinosis
- Secondary Syphilis
- Leprosy
What conditions can cause loss of the eyebrows?
- Seborrhoeic dermatitis
- Discoid lupus erythematosus
What can cause periorbital swelling?
-
Local
- Eyelid infections
- Contact dermatitis
- Orbital tumours
- Chalazion (granulomatous reaction in a Meibomian gland).
-
Systemic
- Angio-oedema
- Dermatomyositis
- Renal disease
- Cardiac failure
- Thyroid disease
- Superior vena caval syndrome
- Bacterial, viral or parasitic/protozoal infections.
What is this?
Syringiomas
(A Form of benign lesion)
What are these?
Milia
What is the most common form of cancer around the eye?
BCC
(70% of malignant eyelid tumours are BCCs)
What are some postoperative problems of BCC eyelid surgery?
- Tear flow problems
- Recurrent infections
- Local Reocurrence of the tumour is common.
What is this?
Sebaceous carcinoma of the lower eyelid.
it can mimic a chalazion.
What is this?
BCC of the lower eyelid
Bleparitis is associated with what condition?
Seborrheic dermatitis
90% of oral cancers are what type of cancer?
Squamous Cell Carcinomas
What oral areas are most commonly affected?
The Lips (30%)
The Tongue (25%)
How do intra-oral neoplasia usually present?
- Persistent erythroplasia
- Persistent ulceration especially with fissuring or raised margins
- Persistent lump
- Fixed induration
- Leukoplakia
- Unexplained local lymphadenopathy.
What are the causes of intra-oral neoplasia?
- Smoking
- Chewing tobacco
- Alcohol
- Poor oral hygeine.
- Chronic inflammation from Lichen planus
- Rare: Plummer-Vinson Syndrome
What is this and what should you do?
This is leukoplakia. It needs to be biopsied.
What is this?
Oral hairy leukoplakia
- Caused by the Epstein-Barr virus
- Common in HIV patients if poorly controlled.
What is this?
Chondrodermatitis nodularis Helicis
Who is CNH (Condrodermatitis nodularis helicis) more common in?
Middle-aged or elderly patients
What causes CNH/
It is a form of pressure sore
It is commonly misdiagnosed as a BCC, SCC or SK.
What are the treatment options for CNH?
- Topical steroids
- Cryotherapy
- Excision of the nodule and a portion of the inflammed cartilage.
What can commonly cause contact dermatitis in the ear?
- Hair products
- Plastic or rubber ear appliances
- Objects used to blean the ear (hairpins, matches)
- Topical medication
- Neomycin
- Propylene glycol.
