Colors of pathology 1 Flashcards
If you have something that looks like a retrocuspid papilla but is not bilateral what is your differential?
- Bump on the gums
- Pyogenic granuloma
- Peripheral giant cell granuloma
- Peripheral ossifying fibroma
- IFH
Why are white lesions white?
- Because of thickened epithelial covering
- Decreased vascularity
- Increased collagen
What are some white lesions that cause thickened epithelial coverings?
- Hyperkeratosis
- Acanthosis
- Dysplasia
- Carcinoma
What is a white lesions that causes increased collagen?
-Submucous fibrosis
Why are red lesions red?
- Thinner epithelium
- Increased vascularity
- Dissolution of the collagen content
Why are blue lesions blue?
- Venous blood collection as opposed to the red of arterial blood
- Tyndall effect (all wavelengths are absorbed except blue)
- Medications
Why are black lesions black?
- Melanin
- Heavy metals
Why are brown lesions brown?
- Melanin
- Hemosiderin
What is hemosiderin?
-Yellowish brown granular pigment formed by breakdown of hemoglobin found in phagocytes
Why are yellow lesions yellow?
- Adipose tissue
- Sebaceous material (skin oil)
- Pus
What is the differential of a white lesion that can be scraped, or rubbed off?
- Materia alba
- Burns (thermal or chemical)
- Candidiasis
- Fibrin membrane
- White coated tongue
- Exudate
What is the differential of a white lesion that can NOT be scraped or rubbed off?
- Leukoplakia
- Leukoedema
- Lichen planus
- Linia alba
- Morsicatio
- Nicotine stomatitis
- Tobacco pouch keratosis
What are the treatment options for morsicatio buccarum, labiorum, or linguarum?
- Bite guard
- None
What is a common cancer that comes from smokeless tobacco use?
-Verrucous carcinoma (25% can be squamous cell carcinoma)
What do skin lesions that are associated with lichen planus look like?
- Purple
- Pruritic (itchy)
- Polygonal
- Papule
What is the treatment for lichen planus (chronic inflammatory disease)?
-Topical steroid is a good start before using a systemic
What is clobetasol proprionate .05% gel?
-It is a topical steroid (high potency)
what can too much steroid cause?
-yeast infection
What is Decadron aka?
-Dexamethasone elixir
What is Dexamethasone elixir?
-Topical steroid
What two topical steroid have a black box warning for external use only?
-Lidex and Clobetasol (you can ignore this)
How do you decide whether do use a gel or an elixir?
- Size of lesions
- Frequency of recurrences
- Number of lesions
- Location of lesions
What is Clobetasol proprionate aka?
-Temovate
What size of tubes do Clobetasol proprionate come in?
-15 g or 30 g tubes (usually start with 15 unless they have to use it daily because there lesions came back after use)
What is the sig (instructions) for how to use clobetasol proprionate?
-Dry the affected area and gently apply a thin amount bid-tid (twice or three times daily)
What percent of clobetasol proprinoate do you use?
-.05% gel
What is the concentration of dexamethasone elixir that you use?
.5mg/ml
How much dexamethasone elixir do you dispense?
-12-16 oz (480ml)
What are the instructions (sig) for dexamethasone elixir?
-Rinse with 1 tsp for 2 minutes bid-qid (so three is a good middle number) and expectorate
What is fluocinonide aka?
-Lidex
What concentration of fluocinonide do you use?
-.05% gel (moderate potency)
How much fluocinonide (lidex) do you dispense?
-15g or 30 g tube
What are instructions (sig) for fluocinonide (lidex)?
-Dry the affected area and gently apply a thin amount 3-4 times daily
What is the treatment for oral hairy leukoplakia?
-Treat AIDS
What is the treatment for nicotine stomatitis?
-Discontinue use
What are red and white lesions?
- Recurrent apthous ulcers
- Herpetic ulcers
- Traumatic ulcer (TUGSE)
- Geographic tongue (erythema migrans)
- Actinic keratosis
- Erythroleukoplakia
What is the treatment for traumatic ulcer?
- steroids
- Cut it out (to remove dead skeletal muscle and tissue)
- Watch it
What are some intra-lesional injections that can be used to treat TUGSE?
- Kenalog 10 (10 mg/ml)
- kenalog 40 (40 mg/ml)
How much kenalog do you use when treating TUGSE?
-10 mg per centimeter of lesional tissue
What is the treatment for geographic tongue?
-Nothing
What is a differential for desquamative gingivitis?
- Lichen planus
- Mucous membrane pemphigoid
- Pemphigus vulgaris
- Systemic lupus erythematosis
- Hypersensitivity
What is the treatment for desquamative gingivitis?
- Biopsy for confirmation
- Topical steroids
What is actinic chelosis?
-A pre-malignant lesion
