immune mediated mucocutaneous lll and lV Flashcards
Cutaneous Lichen Planus is a ____ ____ disease
immune mediated
Cutaneous Lichen Planus affects who
1% 30-60 years old
females
Cutaneous Lichen Planus, what does it look like?
Purple pruritic polygonal papules with Wickham’s striae
Cutaneous Lichen Planus where on the body is it found
Flexor surface of wrists, lumbar region, shins
Cutaneous Lichen Planus, how long does it last?
1-2 years disease course.
Oral Lichen Planus
may occur alone or with skin lesions. adults females
Oral Lichen Planus, where is it found in the oral cavity
bilateral buccal mucosa, tongue, gingiva
reticular form is most common
erosive form is most symptomatic
Oral Lichen Planus which form is most common
reticular
Oral Lichen Planus which form is most symptomatic
erosive
Oral Lichen Planus, how long can it last
years to decades
Reticular Oral Lichen Planus
interlacing white lines
dorsal tongue involvment
patchy keratosis and atrophy
erosive LP:
shallow ulcers, peripheral erythema and radiating white lines
_______ may be superimposed over either
C. albicans
Histopath characteristics of LP
characteristic microscopic features but these must be correlated with the clinical setting
Hyperkeratosis, alternating atrophy/thickening of spinous layer, pointed rete ridges, degeneration of the basal cell layer and a band-like infiltrate of lymphocytes
treatment of the different LP’s
reticular- no treatment
erosive- stronger topical corticosteroids
prognosis of LP
good
is LP premalignant
to evidence to support this, no
Lichenoid Mucositis
A number of conditions can mimic oral lichen planus, both clinically and histopathologically
Lichenoid drug reaction; lichenoid amalgam reaction; oral mucosal cinnamon reaction; lichenoid foreign body gingivitis; oral lesions of GVHD or lupus erythematosus; some epithelial dysplasias

Systemic Lupus Erythematosus is the most common of significant immune mediated diseases true or false
TRUE
1.5 mill affected in US
Systemic Lupus Erythematosus, whose affected the most
women 8 to 10 times more
average age 31
SLE clinically
- Protean manifestations initially
- Fever, weight loss, arthritis, fatigue, malaise
- Malar “butterfly” rash
- Skin lesions flare with sun exposure
this organ is often involved with SLE
Kidney 40-50%
most significant clinical complication with SLE
renal failure
can also see this organ affected by SLE
cardiac, pericarditis
50% have vegetation on heart valves
frequency of oral involvement?
5-25%
SLE oral lesions appear as…..
May appear as non-specific or lichenoid ulcerations/keratotic areas
SLE affects what in the oral cavity?
Affect palate, buccal mucosa, or gingiva
can use topical corticosteroids to heal
diagnosis of SLE is based on what
clinical, histopathologic, immunopathologic, & serologic findings
SLE has a ______ microscopically
Lichenoid pattern
SLE has a positive ____ ____ ____, meaning
lupus band test, deposition of immunoreactants at BMZ of normal skin
_______ are present 95% of the time, especially to dsDNA
Anti-nuclear antibodies
treatments for SLE
avoiding expsure to UV light
NSAID’s for mild disease
systemic corticosteroids for moderate cases
prognosis is worse for me or women?
men
prognosis of SLE
5 year is 95%
20 year is 75%
most common cause of death of SLE is what
renal failure
Chronic Cutaneous Lupus
Related to SLE, but allmost exclusively affects skin and mucosa
chronic cutaneous lupus clincal
Scaly, erythematous patches appear on sun-exposed skin of the head and neck
Scarring and atrophy as these lesions heal
oral lesions of chronic cutaneous lupus resemble what
erosive LP
Microscopic examination of oral lesion shows….
lichenoid mucositis and vasculitis
Serologic studies typically negative or positive for anti- nuclear antibodies?
negative
treatment of chronic cutaneous lupus includes
- avoiding UV light
- Topical corticosteroids or calcineurin inhibitors are often helpful with either cutaneous or oral lesions
- More difficult cases may require systemic anti-malarial drug therapy or low-dose thalidomide
is prognosis better or worse than SLE?
better
chance of CCL transforming into SLE?
5%
T/F in 50% of cases the skin lesions resolve after several years
true
Systemic Sclerosis also called what
scleroderma
Systemic sclerosis is a Relatively rare condition characterized by…..
inappropriate deposition of dense collagen
probably immune related
systemic sclerosis affects who?
women 3-5 times more
adult
systemic sclerosis clinical
- Raynaud’s phenomenon; claw-like deformity of fingers; acro-osteolysis
- Diffuse smooth, hard texture of skin
- Pulmonary, renal, cardiac and GI fibrosis may be seen
- Pulmonary fibrosis leads to hypertension and heart failure
systemic sclerosis oral problems
- Microstomia, with pinched, “purse-string” appearance of mouth
- Dysphagia with esophageal involvement
- Diffuse widening of periodontal ligament
- Resorption of posterior ramus, condyle, coronoid process or chin in 10-20%
systemic sclerosis Serologic studies show….
autoantibodies directed against Scl-70 (topoisomerase I)
systemic sclerosis, _____ is seen in biopsy of organs
dense collagen deposition
Anticentromere antibodies associated more with…..
CREST syndrome
systemic sclerosis treatment
No uniformly effective treatment
Supportive care includes esophageal dilation, calcium channel blockers to ease Raynaud’s symptoms, ACE inhibitors to control hypertension
Problems with oral hygiene/prostheses
55-60% with diffuse disease survive 10 years; 75-80% with limited disease
CREST Syndrome
Milder variant of systemic sclerosis Calcinosis cutis, Raynaud’s phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia
CREST syndrome affects who the most
women, 6th and 7th decade
better or worse prognosis than systemic sclerosis
better
treatment for CREST syndrome
symptomatic care.
