Chapter 16-Derm Dz 5 Flashcards
OLP: Age group, gender, and prevalence stats plz
Age: middle aged adults….3:2 Female:Male…0.1-2.2% of the population with OLP (1% for cutaneous LP)
What are the 4 p’s of the clinical appearance of cutaneous lichen planus?
- purple 2. puritic 3. polygonal 4. papules
Slam dunk: the surface of the skin papules in LP
reveals a fine, lacelike network of white lines called:
Wickham striae
What is the term for pigmentation that can accompany the reticular striae of LP?
post-inflammatory melanosis
What superficial lesion can be associated with mucosal areas involved by lichen planus?
superficial mucoceles
What is the term for a severe erosive lichen planus that causes epithelial separation from the underlying CT?
Bullous lichen planus
What are the 6 histologic differentials for LP in Neville?
- 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
What are 4 histologic characteristics of LP? BUZZWORDS
1.Saw toothed rete ridges 2. hydropic (liquefactive) degeneration 3. Band-like infiltration of T-lymphocytes 4. Degenerating keratinocytes (CIVATTE bodes)
What can give LP histology worrisome (dysplastic) features?
candidal infection
What is Neville’s best argument against LP being pre-malignant?
LOH studies found the molecular profile of LP to resemble that of normal or reactive mucosa
What is the nuclear protein that is targeted by autoantibodies in CUS?
Delta-Np63alpha (a 70kD isoform of p63)
What entity resembles CUS the most? Why is it critical to distinguish the two using DIF?
Erosive LP….CUS does not respond to coritcosterioids (tx CUS with antimalarials)
What type of drug is used to treat CUS?
antimalarial
CUS - age and gender
late 6th decade, female
What % of CUS patients develop lichenoid skin lesions?
fewer than 20%
Which autoantibody is most prominent in CUS? (directed against the nuclei of stratified squamous epithelial cells in basal and parabasal regions of the epithelium)
usually IgG
What two entities also show ANA deposition on DIF, but are found thorughout the thickness of the epi and thus distinguished from CUS?
Systemic sclerosis and Lupus erythematosus
GVHD occurs mainly with what type of transplant?
Allogenic bone marrow transplant
What is used to match a donor and recipient for bone marrow transplant?
HLA (Human Leukocyte Antigen)
What 4 factors generally yield a more mild GVHD following allogenic BM tx?
Better HLA match, younger, used cord blood, and are female
What defines ACUTE GVHD?
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)
What % of BM tx recipients experience acute GVHD?
50%. Holy shit.
What is the spectrum of severity of the skin lesions in Acute GVHD?
mild rash to severe sloughing resembling TEN
What is the time frame for Chronic GVHD? What % range of transplant patients are expected to experience it?
either a continuance of acute GVHD (under 100 days) or up to several years after tx……….30-70%
What are the 5 mimics of GVHD? What is one oral clinical mimic that needs to be considered with burning symptoms?
1.SLE 2.SjogrenSyn 3.Primary biliary cirrhosis 4. lichen planus (skin) 5.systemic sclerosis (skin)……Oral: candidiasis
What (large) % range of Acute GVHD patients will have oral manifestations? What % of chronic GVHD?
33-75% lol for acute and >80% for chronic
Histo of GVHD resembles what 2 entities?….what is the main difference?
LP and systemic sclerosis…but the inflammatory response in GVHD is not as intense as LP
What light therapy has shown to improve the cutaneous and oral lesions in GVHD?
PUVA (psoralen and ultraviolet A)
What % of ‘Mericans have psoriasis? What cell type is proliferating in this condition? What is the word psoriasis derived from in Greek?
2%… increased proliferation of cutaneous keratinocytes (caused by activated T-lymphocytes)…Psoriasis = itching in Greek
What age does psoriasis appear? What times of the year?
2nd, 3rd decades…improve in summer and worse in winter
What is the BUZZWORD for the clinical appearance of the cutaneous lesions of psoriasis? What is the BUZZWORD for the histologic feature?
“silvery scale”…munro abscesses
What is the complication affecting 11% of psoriasis patients? What oral/maxillofacial structure can it affect?
psoriatic arthritis…the TMJ
How often are psoriasis lesions seen in the oral cavity?
‘distinctly uncommon’
What are the two histologic mimics of oral psoriaiais?
1.erythema migrans 2.oral mucosal cinnamon reaction
What treatment for psoriasis can increase the risk of SCC after 350 doses?
PUVA (psoralen and ultraviolet A)
What is the most common collagen vascular / connective tissue disease in the US?
Lupus erythematosus
Which cell population has increased activity in SLE and which has abnormal function?
B lymphocytes increased activity, T lymphocytes abnormal function
Which form of lupus primarily affects the skin and oral mucosa, and the prognosis is good?
Chronic cutaneous lupus erythematosus (CCLE)
Which form of lupus has clinical features intermediate
between those of SLE and CCLE?
Subacute cutaneous lupus erythematosus (SCLE)
What is the average age at dx for SLE? Gender?
31 years…females 8-10x more freq
What is the name of the characteristic rash in SLE and what % range of patients have this?
butterfly rash…40-50%
What % range of SLE patients have renal involvment?
40-50%
What is the most common cardiac complication of SLE?
pericarditis
What is the BUZZWORD for warty vegitations affecting the heart valves of SLE patients?
Libman-Sacks Endocarditis
What (large) % range of SLE patients have oral lesions? What do they most often resemble clinically?
5-40% lol…lichenoid
What is the term of an SLE lesion that involves the vermillion zone of the lower lip?
lupus cheilitis
The skin lesions of CCLE most commonly present as?
discoid lupus erythematosus
Conjunctival involvement by CCLE
has rarely been reported to cause cicatrizing conjunctivitis, clinically similar to _____?
mucous membrane pemphigoid
oral manifestations of CCLE essentially appear clinically identical to the lesions of ?
erosive lichen planus
What is the main clinical difference between CCLE and ELP?
ELP = in mouth, rare on skin VS CCLE = in mouth, likely on skin
Histo for CCLE: buzzword for skin lesions
“follicular plugging”
What are the 3 histo differences between LP and LE?
- LE = patchy deposits of PAS positive material in the BM zone
- Subepi edema
- diffuse, deep inflammation (surrounding vessels)
What are the three immunoreactants associated with LE using DIF? What is a BUZZWORD for the DIF appearance?
IgM, IgG, C3…shaggy or granular band at the BM zone
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?
positive lupus band test….1)Rheumatoid arthritis 2)Sjogren syndrome 3)systemic sclerosis
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.
doublestranded DNA….Sm
UV sunlight helps ______ lesions, but exacerbates ______ lesions
helps psoriasis, exacerbates lupus
Whats the 20 year survival for SLE?
75%
