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Oral and Maxillofacial Pathology > Chapter 16: Dermatologic Diseases II > Flashcards

Chapter 16: Dermatologic Diseases II Flashcards

1
Q

mucous membrane pemphigoid may also be termed ___, and is twice as common as ___

A
  • cicatricial pemphigoid (cicatrix means “scar”)
  • twice as common as pemphigus
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2
Q

what is the average age and gender predilection for someone with mucous membrane pemphigoid?

A
  • 55
  • F:M 2:1
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3
Q

mucous membrane pemphigoid oral lesions begin as ___ or ___ which eventually rupture and leave ___

A
  • vesicles or bullae
  • ulcerated mucosa
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4
Q

describe the oral lesions in mucous membrane pemphigoid

A
  • intraoral blisters may be seen clinically (unlike with pemphigus)
    • an intraoral blood blister is virtually pathognomonic
  • unlike other lesions in this disease, oral lesions usually don’t scar
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5
Q

what is the most significant complication of mucous membrane pemphigoid?

A

ocular involvement (up to 25%)

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6
Q

the earliest ocular change in mucous membrane pemphigoid can be detected via ___ examination by an ophthalmologist

A

slit-lamp

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7
Q

as mucous membrane pemphigoid progresses, what can happen with the eyes?

A
  • conjunctiva become inflamed and eroded, and attempts at healing lead to scarring
  • adhesions, called symblepharons, result
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8
Q

describe symblepharons associated with mucous membrane pemphigoid

A
  • scarring can turn the eyelids inward (entropion), which causes the eyelashes to rub against the cornea
  • scarring can close opening of lacrimal glands
  • after all this happens, the cornea produces keratin as a protective mechanism
    • keratin is opaque, so this leads to blindness
  • blindness can also occur by the upper and lower eyelids scarring together
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9
Q

what are the histopathologic features of mucous membrane pemphigoid?

A

autoantibodies are directed against the basement membrane, leading to a subepithelial split (interepithelial)

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10
Q

direct immunofluorescence of mucous membrane memphigoid shows ___ and ___ along the basement membrane

A

C3 and IgG

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11
Q

what is the treatment for mucous membrane pemphigoid?

A
  • first part of treatment is to refer to an ophthalmologist, regardless of if the patient has symptoms
  • topical corticosteroids are used first; if they are unsuccessful, systemic agents may be used
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12
Q
A

mucous membrane pemphigoid

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13
Q

___ is a blistering, ulcerative mucocutaneous condition of uncertain etiopathogenesis, which is likely immunologically mediated

A

erythema multiforme

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14
Q

in 50% of erythema multiforme cases, the clinician can identify a preceding infection or exposure to a medication. what is the infection? what are the medications?

A
  • infection is usually herpes simplex or mycoplasma pneumoniae
  • medications are usually antibiotics or analgesics
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15
Q

describe the disease spectrum of erythema multiforme

A
  • erythema multiforme minor
  • erythema multiforme major - aka stevens-johnson syndrome
  • toxic epidermal necrolysis - aka lyells disease
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16
Q

is the onset of erythema multiforme acute or chronic? describe mild vs severe cases

A
  • acute
  • in mild cases, ulcerations affecting the oral mucosa develop
  • in severe cases, the entire skin and mucosal surfaces may slough
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17
Q

what patients are usually affected by erythema multiforme?

A

young adults in their 20s-30s, M>F

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18
Q

what are the prodromal symptoms of erythema multiforme? how long before onset do they occur?

A

fever, headache, cough, sore throat occur 1 week before onset

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19
Q

how long does erythema multiforme last? what % of cases have recurrent episodes?

A
  • 2-6 weeks
  • 20%
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20
Q

what percent of patients with erythema multiforme develop skin lesions?

A

50%

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21
Q

describe the skin lesions associated with erythema multiforme

A
  • early lesions are typically flat, round, and red
  • lesions become elevated and evolve into bulla with necrotic centers
  • a highly characteristic skin lesion that develops is a target lesion
    • concentric circular erythematous rings resembling a target or bulls-eye
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22
Q

describe the oral lesions associated with erythema multiforme

A
  • erythematous patches that undergo epithelial necrosis and ulcerate
  • entire oral cavity can be involved except the gingiva and hard palate
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23
Q

what is a common presentation of the lips with someone who has erythema multiforme?

A

hemorrhagic crusting of the vermillion zone

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24
Q

erythema multiforme lesions emerge quickly and are painful. what is a potential problems this poses for patients?

A

patients may become dehydrated due to an inability to ingest liquids

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25
Q

stevens-johnson syndrome is also known as ___

A

erythema multiforme major

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26
Q

which form of erythema multiforme is usually triggered by a drug and must have skin, oral mucosa, and either ocular or genital mucosa involvement to be diagnosed?

A

steven-johnson syndrome (EM major)

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27
Q

which form of erythema multiforme is the most severe form, is almost always triggered by a drug, and involves diffuse sloughing of the skin and mucosa?

A

toxic epidermal necrolysis

28
Q

toxic epidermal necrolysis tends to occur in what age patient, and what gender more commonly?

A
  • older people (EM minor and major are younger people)
  • F>M (unlike EM minor)
29
Q

if a patient with toxic epidermal necrolysis survives, what happens to the cutaneous process?

A

typically resolves in 2-4 weeks

30
Q

describe the management of erythema multiforme

A
  • discontinuation of the causative drug is paramount
  • if due to herpes, daily antivirals are indicated
  • patient is usually admitted to hospital for IV fluids
  • steroids are used in EM minor and major but are contraindicated in toxid epidermal necrolysis
  • TEN patients are treated in the burn unit
31
Q

what is the mortality rate for patients with erythema multiforme major?

A

up to 10%

32
Q

what is the mortality rate for patients with toxic epidermal necrolysis?

A

about 35%

33
Q
A

erythema multiforme

34
Q

what are two other names for erythema migrans?

A

geographic tongue and benign migratory glossitis

35
Q

erythema migrans is a common condition that primarily affects the ___, affects ___% of the population, and is two times more common in which gender?

A
  • tongue
  • 3%
  • F:M 2:1
36
Q

erythema migrans may be related to what condition?

A

psoriasis

37
Q

erythema migrans lesions characteristically appear where on the tongue?

A
  • anterior 2/3 of the dorsal tongue
    • concentrated on the tip and lateral borders
38
Q

erythema migrans may occur in places other than the tongue. what helps with identifying these lesions as erythema migrans?

A

they will have a serpentine border

39
Q

how do erythema migrans lesions develop?

A
  • begin as multiple, small white patches which develop central erythematous atrophic zones and enlarge into well-demarcated zones of erythema
    • these areas are surrounded at least partially by a slightly elevated, yellow-white, serpentine or scalloped border
  • the lesions will heal in one area and then develop in a different area
40
Q

what other feature is associated with erythema migrans?

A

fissured tongue

41
Q

is erythema migrans symptomatic or asymptomatic?

A

asymptomatic, but some patients may experience burning when eating spicy foods

42
Q

what is the treatment for erythema migrans? is a biopsy required?

A
  • no treatment necessary for asymptomatic erythema migrans
  • symptomatic patients should use topical corticosteroids
  • no biopsy required - it is a clinical diagnosis
    • patients should be assured they have a benign condition
43
Q
A

erythema migrans

44
Q

___ is a common, chronic dermatologic disease that can affect the oral mucosa, and may be due to medications, amalgam, etc

A
  • lichen planus
    • form that results from medications or amalgam is better known as “lichenoid mucositis”
45
Q

what age and gender is most common in patients affected by lichen planus? approximately what percent of the population is affected?

A
  • middle-aged adults
  • F>M
  • 1%
46
Q

describe lichen planus skin lesions (4 Ps)

A
  • purple
  • pruritis
  • polygonal
  • papules
47
Q

do lichen planus skin lesions itch?

A

yes, but the patient doens’t usually scratch because the lesions are painful

48
Q

lichen planus skin papules have a thin, lacelike network of white lines termed ___

A

wickham’s striae

49
Q

what are the two forms of oral lichen planus?

A

reticular and erosive

50
Q

which form of lichen planus oral lesions are much more common and are asymptomatic?

A

reticular

51
Q

describe reticular oral lichen planus

A
  • involves the posterior buccal mucosa bilaterally, seen as wickham’s striae
  • if it occurs on the tongue, the lesions will be plaque-like
  • lesions tend to wax and wane
52
Q

which form of oral lichen planus is symptomatic?

A

erosive

53
Q

describe erosive oral lichen planus

A
  • lesions are atrophic, erythematous areas with a central ulceration
    • periphery is usually bordered by fine, white, radiating striae
  • if confined to the gingiva, it is termed desquamative gingivitis
    • becomes indistinguishable from pemphigus and pemphigoid, which may also be limited to the gingiva
54
Q

how do drug-induced lichen planus lesions typically present?

A

found on the lower lip as non-healing ulcers

55
Q

what are the histopathologic features of lichen planus?

A
  • pointed, “saw-toothed” rete ridges
  • destruction of the basal layer
  • band-like infiltrate of lymphocytes subjacent to the epithelium
  • degenerating keratinocytes within the epithelium (termed civatte bodies)
  • deposition of fibrinogen at the basement membrane via DIF
56
Q

is a biopsy needed for oral lichen planus lesions?

A
  • not if lesions are bilateral AND asymptomatic
    • this is consistent with a clinical diagnosis of reticular oral lichen planus
  • biopsy is indicated if the lesions are symptomatic OR asymmetric
57
Q

what is the treatment for oral lichen planus?

A
  • no treatment is necessary for bilateral AND asymptomatic lesions
  • if lesions are symptomatic OR asymmetric, oral topical steroids are used for treatment
58
Q

28% of women with erosive oral lichen planus also have ___ lesions

A

vaginal

59
Q

what 4 things can oral lichen planus lesions be induced by?

A
  • stress
  • trauma
  • advil (any NSAID, acetaminophen is ok)
  • yeast
60
Q
A

reticular oral lichen planus

61
Q
A

erosive oral lichen planus

62
Q
A

lichen planus

63
Q
A

lichen planus

64
Q
A

lichen planus

65
Q
A

lichen planus

wickham’s striae

66
Q
A

lichen planus skin lesions

Oral and Maxillofacial Pathology (45 decks)

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