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Neville and Damm > Chapter 16-Derm Dz 5 > Flashcards

Chapter 16-Derm Dz 5 Flashcards

1
Q

OLP: Age group, gender, and prevalence stats plz

A

Age: middle aged adults….3:2 Female:Male…0.1-2.2% of the population with OLP (1% for cutaneous LP)

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2
Q

What are the 4 p’s of the clinical appearance of cutaneous lichen planus?

A
  1. purple 2. puritic 3. polygonal 4. papules
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3
Q

Slam dunk: the surface of the skin papules in LP

reveals a fine, lacelike network of white lines called:

A

Wickham striae

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4
Q

What is the term for pigmentation that can accompany the reticular striae of LP?

A

post-inflammatory melanosis

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5
Q

What superficial lesion can be associated with mucosal areas involved by lichen planus?

A

superficial mucoceles

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6
Q

What is the term for a severe erosive lichen planus that causes epithelial separation from the underlying CT?

A

Bullous lichen planus

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7
Q

What are the 6 histologic differentials for LP in Neville?

A
  1. lichenoid drug reaction 2. lichenoid amalgam reaction 3.Oral graft versus host disease (GVHD) 4.Lupus erythematosus (LE) 5. Chronic ulcerative stomatitis 6.Oral mucosal cinnamon reaction
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8
Q

What are 4 histologic characteristics of LP? BUZZWORDS

A

1.Saw toothed rete ridges 2. hydropic (liquefactive) degeneration 3. Band-like infiltration of T-lymphocytes 4. Degenerating keratinocytes (CIVATTE bodes)

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9
Q

What can give LP histology worrisome (dysplastic) features?

A

candidal infection

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10
Q

What is Neville’s best argument against LP being pre-malignant?

A

LOH studies found the molecular profile of LP to resemble that of normal or reactive mucosa

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11
Q

What is the nuclear protein that is targeted by autoantibodies in CUS?

A

Delta-Np63alpha (a 70kD isoform of p63)

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12
Q

What entity resembles CUS the most? Why is it critical to distinguish the two using DIF?

A

Erosive LP….CUS does not respond to coritcosterioids (tx CUS with antimalarials)

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13
Q

What type of drug is used to treat CUS?

A

antimalarial

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14
Q

CUS - age and gender

A

late 6th decade, female

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15
Q

What % of CUS patients develop lichenoid skin lesions?

A

fewer than 20%

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16
Q

Which autoantibody is most prominent in CUS? (directed against the nuclei of stratified squamous epithelial cells in basal and parabasal regions of the epithelium)

A

usually IgG

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17
Q

What two entities also show ANA deposition on DIF, but are found thorughout the thickness of the epi and thus distinguished from CUS?

A

Systemic sclerosis and Lupus erythematosus

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18
Q

GVHD occurs mainly with what type of transplant?

A

Allogenic bone marrow transplant

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19
Q

What is used to match a donor and recipient for bone marrow transplant?

A

HLA (Human Leukocyte Antigen)

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20
Q

What 4 factors generally yield a more mild GVHD following allogenic BM tx?

A

Better HLA match, younger, used cord blood, and are female

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21
Q

What defines ACUTE GVHD?

A

occurring 2 weeks to 100 days followng of the transplant (but now more clinically focused and not on just a timepoint) (also, before 2 weeks = chemo conditioning or neutropenia, after 100 days = chronic GVHD)

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22
Q

What % of BM tx recipients experience acute GVHD?

A

50%. Holy shit.

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23
Q

What is the spectrum of severity of the skin lesions in Acute GVHD?

A

mild rash to severe sloughing resembling TEN

24
Q

What is the time frame for Chronic GVHD? What % range of transplant patients are expected to experience it?

A

either a continuance of acute GVHD (under 100 days) or up to several years after tx……….30-70%

25
Q

What are the 5 mimics of GVHD? What is one oral clinical mimic that needs to be considered with burning symptoms?

A

1.SLE 2.SjogrenSyn 3.Primary biliary cirrhosis 4. lichen planus (skin) 5.systemic sclerosis (skin)……Oral: candidiasis

26
Q

What (large) % range of Acute GVHD patients will have oral manifestations? What % of chronic GVHD?

A

33-75% lol for acute and >80% for chronic

27
Q

Histo of GVHD resembles what 2 entities?….what is the main difference?

A

LP and systemic sclerosis…but the inflammatory response in GVHD is not as intense as LP

28
Q

What light therapy has shown to improve the cutaneous and oral lesions in GVHD?

A

PUVA (psoralen and ultraviolet A)

29
Q

What % of ‘Mericans have psoriasis? What cell type is proliferating in this condition? What is the word psoriasis derived from in Greek?

A

2%… increased proliferation of cutaneous keratinocytes (caused by activated T-lymphocytes)…Psoriasis = itching in Greek

30
Q

What age does psoriasis appear? What times of the year?

A

2nd, 3rd decades…improve in summer and worse in winter

31
Q

What is the BUZZWORD for the clinical appearance of the cutaneous lesions of psoriasis? What is the BUZZWORD for the histologic feature?

A

“silvery scale”…munro abscesses

32
Q

What is the complication affecting 11% of psoriasis patients? What oral/maxillofacial structure can it affect?

A

psoriatic arthritis…the TMJ

33
Q

How often are psoriasis lesions seen in the oral cavity?

A

‘distinctly uncommon’

34
Q

What are the two histologic mimics of oral psoriaiais?

A

1.erythema migrans 2.oral mucosal cinnamon reaction

35
Q

What treatment for psoriasis can increase the risk of SCC after 350 doses?

A

PUVA (psoralen and ultraviolet A)

36
Q

What is the most common collagen vascular / connective tissue disease in the US?

A

Lupus erythematosus

37
Q

Which cell population has increased activity in SLE and which has abnormal function?

A

B lymphocytes increased activity, T lymphocytes abnormal function

38
Q

Which form of lupus primarily affects the skin and oral mucosa, and the prognosis is good?

A

Chronic cutaneous lupus erythematosus (CCLE)

39
Q

Which form of lupus has clinical features intermediate

between those of SLE and CCLE?

A

Subacute cutaneous lupus erythematosus (SCLE)

40
Q

What is the average age at dx for SLE? Gender?

A

31 years…females 8-10x more freq

41
Q

What is the name of the characteristic rash in SLE and what % range of patients have this?

A

butterfly rash…40-50%

42
Q

What % range of SLE patients have renal involvment?

A

40-50%

43
Q

What is the most common cardiac complication of SLE?

A

pericarditis

44
Q

What is the BUZZWORD for warty vegitations affecting the heart valves of SLE patients?

A

Libman-Sacks Endocarditis

45
Q

What (large) % range of SLE patients have oral lesions? What do they most often resemble clinically?

A

5-40% lol…lichenoid

46
Q

What is the term of an SLE lesion that involves the vermillion zone of the lower lip?

A

lupus cheilitis

47
Q

The skin lesions of CCLE most commonly present as?

A

discoid lupus erythematosus

48
Q

Conjunctival involvement by CCLE

has rarely been reported to cause cicatrizing conjunctivitis, clinically similar to _____?

A

mucous membrane pemphigoid

49
Q

oral manifestations of CCLE essentially appear clinically identical to the lesions of ?

A

erosive lichen planus

50
Q

What is the main clinical difference between CCLE and ELP?

A

ELP = in mouth, rare on skin VS CCLE = in mouth, likely on skin

51
Q

Histo for CCLE: buzzword for skin lesions

A

“follicular plugging”

52
Q

What are the 3 histo differences between LP and LE?

A
  1. LE = patchy deposits of PAS positive material in the BM zone
  2. Subepi edema
  3. diffuse, deep inflammation (surrounding vessels)
53
Q

What are the three immunoreactants associated with LE using DIF? What is a BUZZWORD for the DIF appearance?

A

IgM, IgG, C3…shaggy or granular band at the BM zone

54
Q

DIF testing of clinically normal skin of SLE patients often shows a similar deposition of IgG, IgM, or complement components…whats this test called? What 3 other conditions can also show this?

A

positive lupus band test….1)Rheumatoid arthritis 2)Sjogren syndrome 3)systemic sclerosis

55
Q

Antibodies directed against _________ are noted in 70% of patients with SLE, another 30% of
patients show antibodies directed against _______, a protein that is complexed with small nuclear RNA. This finding is very specific for SLE.

A

doublestranded DNA….Sm

56
Q

UV sunlight helps ______ lesions, but exacerbates ______ lesions

A

helps psoriasis, exacerbates lupus

57
Q

Whats the 20 year survival for SLE?

A

75%

Neville and Damm (72 decks)

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