Disease & Mucosa Disease- Part 2 Flashcards
Common, chronic disease that affects skin & oral mucosa that is an immune mediated mucocutaneous disorder:
Lichen planus
What may cause a similar appearance to lichen planus? What is this called?
Medications; lichenoid mucositis
List the clinical features of lichen plaque:
- MC in middle-aged females
- skin lesions
Describe the skin lesions associated with lichen planus:
-often affect flexor surfaces of extremities
(4 P’s)
1. purple
2. pruritic
3. polygonal
4. papules
4 P’s to lichen planus skin lesions
- purple
- pruritic
- polygonal
- papules
What type of lichen planus is the most common?
Reticular type
Describe the clinical features of the RETICULAR TYPE of lichen planus:
- involves buccal mucosa bilaterally
- interlacing white lines (Wickham striae)
- Wax & wane
- post-inflammatory melanosis
- usually asymptomatic
Describe the clinical features of the EROSIVE TYPE of lichen planus:
- atrophic, erythematous areas with central ulceration
- patients often symptomatic
- periphery bordered by fine, white radiating striae
- atrophy & ulceration confined to the gingiva (desquamative gingivitis)
How do you diagnose lichen planus?
Clincal, histopathology, direct immunofluorescence
10% Formalin vs. Michels solution
What treatment is indicated for lichen planus?
Reticular: usually asymptomatic no treatment is needed
Erosive: topical corticosteroids
Diagnose the following image:
Lichen planus
Diagnose the following image:
Lichen planus
Diagnose the following image:
Lichen planus
Diagnose the following image:
Lichen planus
Diagnose the following image:
Lichen planus
Diagnose the following image:
Lichen planus
Diagnose the following image:
Lichen planus
Diagnose the following image:
Lichen planus
Diagnose the following image:
Lichen planus
Diagnose the following image:
Lichen planus
Diagnose the following based on the histological image:
Lichen planus
Diagnose the following based on the histological image:
Lichen planus
Ulcerative mucocutaenous condition of uncertain etiology but likely an immune mediated process:
Erythema multiforme
50% of erythema multiform causes have a ____ cause. Give some examples
Precipitating cause- infections (HSV) & mediations (infrequently)
List the clinical features of erythema multiform:
- observed in young adults (20s-30s)
- Prodromal symptoms (fever, malaise, headache, cough)
- slightly elevated. round, dusky-red patches on skin
- concentric, circular, erythematous rings (target lesion)
Where is the most frequently involved mucosal site for erythema multiform?
oral cavity
Although the oral cavity is the most frequently involved mucosal site for erythema multiforme, other mucosa may be involved including:
- genitourinary
- ocular
- respiratory
Describe the oral lesions associated with erythema multiforme:
shallow erosions or ulcerations with irregular borders located on the lips, labial & buccal mucosa, tongue, FOM & soft palate
Describe what can occur with the lips in a patient with erythema multiforme:
hemorrhagic crusting of vermillion zone
Describe the clinical features of erythema multiforme MINOR:
-milder cases
-skin lesions & 1 mucosal site (usually oral)
Describe the clinical features of erythema multiforme MAJOR:
-more severe
-widespread skin lesions & 2 or more mucosal sites
-severe ocular involvement (scarring & symblepharon formation)
What is the indicated treatment for erythema multiforme?
Usually self-limiting in 2-6 weeks but may use systemic or topical corticosteroids
Diagnose the following image:
erythema multiforme
Diagnose the following image:
erythema multiforme
Diagnose the following image:
erythema multiforme
Diagnose the following image:
erythema multiforme
Diagnose the following image:
erythema multiforme
Severe blistering diseases triggered by drug exposure include:
- Steven-Johnson syndrome (SJS)
- Toxic epidermal necrolysis (TEN)
Describe Steven-Johnson syndrome (SJS):
Less than 10% of skin & mucosal involvement
Describe Toxic epidermal necrolysis (TEN):
Greater than 30% of skin & mucosal involvement
Clinical features of SJS are usually seen in:
younger patients
Clinical features of TEN are usually seen in:
patients above 60 years
Both SJS & TEN initially present with ____ and after a few days ______ appear on the ____
flu-like symptoms; cutaneous lesions; trunk