Dermatology II Flashcards
Name some types of mucocutaneous lesions
- Lichen planus
- Lichenoid reaction
- Discoid lupus erythematosus
What parts of the body does Lichen Planus tend to present in
Oral
Cutaneous
Genital
What kind of disease and presentations does lichen plants show
- Premalignant condition thought to be immunologically mediated
- Wide spectrum of presentation
How long do lichen planus lesions remain
Oral: 4-25 years, mean 7 years
Skin: 18 months on average
What are the oral presentations of Lichen Planus
- Reticular
- Erythematous (atrophic)
- Erosive (Ulcerative)
- Symmetrical - both in mouth and on skin
- Buccal/labial mucosa, tongue, gingiva adherent (very rarely palate, lingual)
What is the koebner phenomenon in Lichen Planus
Lesions in areas of increased friction e.g. occlusal line
What morphological variants of lichen planus lesions can be found
- Papular
- Reticular
- Plaque-like
- Atrophic
- Erosvie (ulcerative)
- Bullous
How does extra-oral Lichen Planus present
- Purple polygonal pruritic papules
- Dystrophic nails
- Lichen planopilaris leading to scarring alopecia
- Ocular, nasal, laryngeal, oesophageal, gastric and bladder
What are wickham’s striae
A surface network of fine white striations from cutaneous LP
Where is cutaneous LP usually found
On flexor surfaces of wrists and shins
What happens when LP affects the nails
Longitudinal grooving and pitting often reversible but can get complete nail loss
What do koebners often show up as
Line of LP
What are the characteristics of vulvovaginal-gingival syndrome
- Often unrecognised
- Usually ulcerative and and symptomatic
- Progressive vulval disease leading to scarring
- Reports of malignant transformation
What are the identifiable aetiologies of the Lichenoid reaction
- Drug induced
- Dental materials
What is the most reliable diagnostic tool of the lichenoid drug reactions
Withdrawal of the drug
What are some drugs that are associated with oral lichenoid reactions
- Beta blockers
- ACE inhibitors
- Diuretics
- Methydopa
- Oral hypoglycaemics
- NSAIDs
- Allopurinol
What are the clinical features of the lichenoid reaction
- Soreness like with LP especially with erosive form
- Often indistinguishable from LP
- May have asymmetric distribution if due to reaction to local materials
- More likely to be erosive form and affect palate and tongue
- Resolves on stopping implicated drug
What types of lupus erythematosus are there
- Systemic lupus erythematosus
- Discoid lupus erythematosus
Describe what systemic lupus erythematosus is
- Multisystemic autoimmune disease
- Autoantibodies generated against a variety of auto antigens e.g. ANA
- Involves vascular and Connective tissues
What does discoid lupus erythematosus present with
- Scaly atrophic plaques in sun-exposed skin
- Round or oval plaques - red, scaly with keratin plugs
- Scarring may cause alopecia
Who is most likely to get systemic lupus erythematosus
Females 8x more likely
What does systemic lupus erythematosus tend to present with
- Serological or haematological changes
- Facial butterfly rash
- Photosensitivity, discoid lesions, diffuse alopecia and vasculitis
- Sun exposure may trigger acute systemic flares
What parts of the body may be involved with discoid lupus erythematosus
Oral and genital mucosa, skin and hair
What management options are there for Discoid lupus erythematosus
- Sun protection
- Potent topical or intralesional corticosteroids, antimalarial
AY BAWS CAN I HABE DE NOTE PLZ
10% of discoid lupus erythematosus may evolve in SLE
What is a vesicle
Small fluid-filled blisters < 5mm in diameter
What is a bulla
Fluid-filled large blister > 5mm in diameter
What is varicella zoster virus and what does it cause
It is the herpes virus that causes chickenpox and shingles
What occurs on primary infection and recurrence of varicella zoster virus
Primary = chicken pox in non immune
Recurrence - shingles, may be a sign of underlying malignancy, immunosuppression
What are the clinical presentations of chicken pox
- Itchy maculopapular rash: back, chest, face 2-3 weeks after initial infection
- Initial site: upper respiratory tract - droplet infection
- May have areas of oral vesicles/ulceration palate/fauces
What are the clinical features of Shingles
- Usually presents on trunk, affecting a single dermatome
Occasional underlying immunosuppression - Often misdiagnosed in pre-dromal phase
- Predilection for cranial nerves V and VII
How common is shingles
Affects 10-20% of british population over lifetime
Who is most commonly affected by dermatitis herpetiformis
- Rare
- Most commonly affects native irish
What are the typical presentations of dermatitis herpetiformis
- Chronic pruritic papulovesicular rash
- Small vesicles on urticated base
- Buttocks, elbows and knees
- Oral: transient superficial blisters - tender non-specific ulcers
- Associated with gluten sensitive enteropathy
What are the clinical features of dermatitis herpetiformis
- May affect younger age group including children
- Smaller bullae and vesicles - hence herpetiform appearance of lesions
- Association with coeliac disease (gluten enteropathy)
What treatment is there for dermatitis herpetiformis
Dietary restriction with gluten free diet and dapsone
How does erythema multiforme present
- Target/Iris lesions, erythematous papule blisters
- Extremities (palms and soles) and mucous membranes
What are the clinical features of erythema multiforme
- Oral lesions - bullae or erythematous base break rapidly into irregular ulcers, bleed, form crusts
- Lips more frequently involved, rare for gingiva to be affected
- Skin and macule and papule, central, pale area surrounded by oedema and bands of erythema -iris type but can also be bullae
What infections can cause Erythema multiforme
HSV (70%) Hepatitis viruses Mycoplasma Bacterial fungal Parasites
What drugs can cause erythema multiforme
NSAIDs
Antifungals
Barbiturates
What are some systemic causes of erythema multiforme
Systemic lupus erythematous
Malignancy
Pregnancy
What is pemphigus vulgaris and what causes it
- Chronic organ-specific autoimmune blistering disease
- Circulating and tissue bound IgG autoantibodies directed against adhesion proteins of desmosomes
- Dissolution of cell-cell adhesion
- Intraepithelial blisters affecting skin and mucosa
What oral features of pemphigus vulgaris are there
- Mouth involved in most cases and is only site involved in over half of cases
- Oral bullae fragile + short lived
- Large shallow non-healing ulcers are typical
- Palate, buccal mucosa and gingival are most commonly affected
What are the management options of pemphigus vulgaris
- Topical corticosteroids - mouthwashses
- Systemic corticosteroids - prednisolone
- Steroid-sparing agents e.g. azathioprine pr mycophenolate mofetil
- IV immunoglobulins
What are the clinical features of cutaneous pemphigus
- Large non healing erosions and ulcers of the skin
- May appear 3/4 months after mouth lesions but opposite may also occur
- Rare to see frank blisters
What is mucous membrane pemphigoid (MMP) and what goes wrong in the body to cause it
- Rare, autoimmune blistering disease of middle aged or elderly
- Circulating and tissue bound antibodies against basement membrane zone
Where can mucous membrane pemphigoid (MMP) be found
Usually a mucosal disease - orogential, conjunctive, larynx and oesophagus
Skin rarely involved, scalp involvement = alopecia
What are the management options for mucous membrane pemphigoid (MMP)
- Topical corticosteroids
- Oral prednisolone
- Oral dapsone
- Oral tetracyclines
- Oral azathioprine
- Oral cyclophosphamide
Who does bullies pemphigoid affect mostly
The elderly
Describe the presentation of bullous pemphigoid
- Initial urticarial eruption precedes onset of blistering
- Tense large blisters involve involve skin of limbs, trunk and flexures
- May be localised to one site
What are some of the management options for treating bullous pemphigoid
- Systemic prednisolone
- +/- azathioprine
- Disease is self-limiting in 50%
- Systemic corticosteroids can be stopped after 2 years
