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Pathology 2 > Diseases of the Oral Mucosa and Skin II > Flashcards

Diseases of the Oral Mucosa and Skin II Flashcards

1
Q

Lichen planus
(3)

A

 Common, chronic disease that affects skin and oral mucosa
 Immune mediated mucocutaneous disorder
 Medications may cause similar appearance: lichenoid mucositis

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2
Q

Lichen planus
 Clinical features:
 MC in
 Skin lesions:
 Often affect

A

middle-aged female adults
purple, pruritic, polygonal, papules (4-P’s)
flexor surfaces of extremities

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3
Q

Lichen planus
 Clinical features:
 Reticular type: most common
(5)

A

 Involves buccal mucosa bilaterally
 Interlacing white lines – Wickham striae
 Wax and wane
 Post-inflammatory melanosis
 Usually asymptomatic

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4
Q

Lichen planus
 Clinical features:
 Erosive type:
(4)

A

 Atrophic, erythematous areas with central ulceration
 Patients often symptomatic
 Periphery bordered by fine, white radiating striae
 Atrophy and ulceration confined to gingiva: desquamative gingivitis

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5
Q

Lichen planus
 Diagnosis:
(2)

A

 Clinical, histopathology, direct immunofluorescence
 10% Formalin vs Michels solution

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6
Q

Lichen planus
 Treatment:
 Reticular:
 Erosive:

A

usually asymptomatic, no tx needed
topical corticosteroids

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7
Q

Erythema multiforme
(3)

A

 Ulcerative mucocutaneous condition of uncertain etiology
 Likely an immune mediated process
 50% of cases: precipitating cause – infections (ie: herpes simplex),
medications (infrequently)

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8
Q

Erythema multiforme
 Clinical features:
 Often observed in
 symptoms
 appearance
 May appear as

A

young adults (20s and 30s)
Prodromal symptoms: Fever, malaise, headache, cough
Slightly elevated, round, dusky-red patches on skin
concentric circular erythematous rings – target lesion

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9
Q

Erythema multiforme
 Clinical features:
 most frequently involved mucosal site
 (3) may be affected
 Oral lesions:
 (5)

A

Oral cavity
Ocular, genitourinary, respiratory mucosa
shallow erosions or ulcerations with irregular borders
Lips, labial mucosa, buccal mucosa, tongue, FOM, soft palate
Hemorrhagic crusting of the vermilion zone of lips

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10
Q

Erythema multiforme
 Clinical features:
 Erythema multiforme minor:

A

milder cases
 Skin lesions and 1 mucosal site (usually oral)

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11
Q

Erythema multiforme
 Clinical features:
 Erythema multiforme major:

A

more severe
 Widespread skin lesions and 2 or more mucosal sites
 Severe ocular involvement: scarring (symblepharon formation)

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12
Q

Erythema multiforme
 Treatment:
(2)

A

 Usually self-limiting (2-6 weeks)
 Systemic or topical corticosteroids

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13
Q

Stevens – Johnson syndrome
and Toxic epidermal necrolysis

 SJS: —% skin and mucosal involvement
 TEN: —% skin and mucosal involvement

A

Severe blistering diseases triggered by drug exposure
<10
>30

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14
Q

Stevens – Johnson syndrome
and Toxic epidermal necrolysis
 Clinical features:
 SJS: age
 TEN: age
 Initially present with
 After a few days,
 May have — changes as well

A

usually seen in younger patients
usually patients above 60 years
flu-like symptoms
cutaneous lesions appear on trunk
mucosal

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15
Q

 After a few days, cutaneous lesions appear on trunk
(2)

A

 Erythematous macules
 Sloughing of the skin, flaccid bullae

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16
Q

Stevens – Johnson syndrome
and Toxic epidermal necrolysis
 Treatment:
(3)

A

 Identify, immediately discontinue offending drug
 Management in burn unit of hospital
 Mortality rate: SJS – 1-5% , TEN – 25-30%

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17
Q

Pemphigus vulgaris
(3)

A

 Autoimmune disease
 Immune attack on desmosomes – intra-epithelial split
 1-5 cases per million people

18
Q

Pemphigus vulgaris
 Clinical features:
 — lesions often first sign of disease, and most difficult to treat
 Avg diagnosis age: — years
 appearance
 Affect any

 Skin lesions:
 Ocular lesions:

A

Oral
50
superficial, ragged erosions and ulcerations
oral mucosal location
Desquamative gingivitis
flaccid vesicles and bullae that rupture quickly
conjunctivitis

19
Q

Pemphigus vulgaris
 Clinical features:
(3)

A

 Lesions persist and progress without treatment
 Lesions are painful
 Skin: positive Nikolsky sign: bulla appears with firm lateral pressure

20
Q

Pemphigus vulgaris
 Diagnosis:
(3)

A

 Clinical, histopathology, direct immunofluorescence
 10% Formalin vs Michels solution
 Perilesional biopsy

21
Q

Pemphigus vulgaris
 Treatment:

A

 Systemic corticosteroids, immunosuppressive drugs

22
Q

Mucus membrane pemphigoid
Cicatricial pemphigoid
 type
 what
 At least – more common compared to pemphigus
 where

A

Autoimmune disease
Chronic, blistering, mucocutaneous disease
2x
Tissue-bound autoantibodies against components of basement membrane (ie:
hemidesmosomes)

23
Q

Mucus membrane pemphigoid
Cicatricial pemphigoid
 Clinical features:
 — years of age
 MC mucosal site:
 mucosa
 Oral lesions:
 May rupture:
 Lesions are —

A

50-60
oral cavity
Ocular, nasal, esophageal, laryngeal, vaginal
vesicles or bullae
large erosions and ulcerations
painful

24
Q

Mucus membrane pemphigoid
Cicatricial pemphigoid
 Clinical features:
 May be observed in

 Most significant complication:
 May result in

A

any intraoral site
Desquamative gingivitis
ocular involvement – symblepharon formation
blindness

25
Q

Mucus membrane pemphigoid
Cicatricial pemphigoid
 Diagnosis:
(3)

A

 Clinical, histopathology, direct immunofluorescence
 10% Formalin vs Michels solution
 Perilesional biopsy

26
Q

Mucus membrane pemphigoid
Cicatricial pemphigoid
 Treatment:
(3)

A

 If only oral lesions present, may be controlled with topical corticosteroids
 Patient should be referred to ophthalmologist
 OHI measures for gingival lesions

27
Q

Bullous pemphigoid
(3)

A

 Autoimmune disease
 Chronic, blistering, mucocutaneous disease
 Tissue-bound autoantibodies against components of basement membrane (ie:
hemidesmosomes)

28
Q

Bullous pemphigoid
 Clinical features:
 age
 — is often an early symptom
 — develop on skin – rupture after several days
 Healing without —

A

75-80 years
Pruritis
Bullae
scarring

29
Q

Systemic sclerosis
Scleroderma
(3)

A

 May be immune-mediated condition
 Dense collagen deposited throughout the tissue
 Most organs of the body affected

30
Q

Systemic sclerosis
 Clinical features:
 gender
 Mainly observed in —
 Often first noticed by
 Skin develops —
 Surface is usually —

A

Females: 2-3x more common
adults
cutaneous changes
diffuse, hard texture
smooth

31
Q

Systemic sclerosis
 Clinical features:
 Involvement of facial skin:
 — develops with perioral involvement
 Tongue becomes —, — may develop
 — may be present
 Nasal ala becomes

 Resorption of

A

smooth, taut, mask-like appearance
Microstomia
stiff, dysphagia
Xerostomia
atrophied – pinched appearance
Raynaud phenomenon
terminal phalanges → shortened clawlike fingers

32
Q

Raynaud phenomenon:

A

vasoconstrictive event triggered by exposure to cold or stress
– often 1st sign of disease (fingers and toes)

33
Q

Systemic sclerosis
 Clinical features:
 Involvement of other organs:
 May eventually lead to
(3)

A

fibrosis of lungs, heart, GI tract
organ failure
 Pulmonary fibrosis → pulmonary hypertension → heart failure

34
Q

Systemic sclerosis
 Radiographic features:
(2)

A

 Widening of the PDL
 Resorption of posterior mandibular ramus, condyle, coronoid process

35
Q

Systemic sclerosis
 Treatment: (2)

A

prognosis is poor
 Systemic medications: penicillamine

36
Q

CREST syndrome
Limited scleroderma

A

Calcinosis cutis, Raynaud phenomenon, Esophageal dysfunction, Sclerodactyly,
Teliangiectasia

37
Q

CREST syndrome
Limited scleroderma
 Clinical features:
 MC gender, age
 Calcinosis cutis:
 Raynaud phenomenon:
 Esophageal dysfunction:
 Sclerodactyly:
 Telangiectasia:

A

female, 6th – 7th decade
movable, subcutaneous nodules
severe vasospasm in fingers/toes
abnormal collagen deposition
finger becomes stiff, skin – smooth, shiny appearance
superficial dilated capillaries

38
Q

Crohn’s disease
what
where
factor implicated
what may precede GI lesions

A

 Inflammatory bowel disease, immune related
 Anywhere in GI tract – mouth to anus
 Genetic factor implicated
 Oral lesions may precede GI lesions

39
Q

Crohn’s disease
 Clinical features:
 MC Dx in – decade
 symptoms (4)
 Weight loss and malnutrition may develop →
 Oral:

A

2nd
Abdominal cramping, pain, nausea, diarrhea
anemia, decreased growth
diffuse, nodular swelling, ulcers

40
Q

 Oral: diffuse, nodular swelling, ulcers
(2)

A

 Cobblestone appearance
 Erythematous macules and plaques

41
Q

Crohn’s disease
 Treatment:
(2)

A

 Oral lesions typically clear with GI treatment
 Sulfasalazine, antibiotics, corticosteroids

Pathology 2 (12 decks)

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