L2 - Vesicular, Ulcerative, and Bullous Lesions Flashcards
recurrent ulcers
recurrent apthous stomatitis
behcet’s disease
acute lesions
herpes simplex virus infection
varicella zoster virus infection
erythema multiforme
chronis lesions
pemphigus
bullous pemphigoid
mucous membrane pemphigoid
recurrent apthous stomatitis
most common soft tissue lesion
requirement for course
common lesions and know how to deal with it
incidence of apthous stomatitis
17%s
associated with apthous stomatitis
hematologic deficiency
- serum iron, folate, vit b 12
etiology of apthous stomatitis
90% vs 20%
- parent with this lesion – 90% more likely to have it
clinical manifestations of minor ulcers (apthous)
less than 1.0 cm, round, shallow, multiple, healing begins within 1 week and completes in 10-14 days
without scars
benign and subclinical a lot of t
clinical manifestations of major apthous ulcers
over 1,0 cm, round, deep, extremely painful, last for months, heal slwly and leave scars, result in decreased mobility
inflammation is simpy
dilated blood vessels caused by ___ whatever it is
clinical housmanifestations of herpetic form apt ulcers
less common, multiple small punctuate ulcers scatterd over the oral mucosa
DD for apthous stomatitis
viral stomatitis, pemphigoid, drug reactions
- biopsy only needed to exclude other lesions
reference ranges for serum iron, folate, b-12, and ferrtin
iron - 50-160 in men 40-150 in woman
folate 1.8- 9.0 ng/ ml
serum b12- 140-170
serum ferritin
male - 15-200
female - 12-150
tx for mild cases - apthous ulcer
orabase paste
- 20% benzocaine -
for maximum strenght pain relief and protective film for long lasting pain relief and protective film on lesions
tx for severe cases of apthous ulcers
listed in?
topical streoid preperations
* listed in increasing potency of anti-inflammatory effect by altering the way the immune system responds to certain stimuli
- ## triamcinolone
- ## flucinonide
- ## clobetasol
- flucinonide - lidex 0.05%
behcet’s disease
autoimmune disease
- recurrent oral ulcers recurrent genital ulcers occular inflammation
etiology of behcet’s disease
cross reactivity antigens –> humoral antibody or cell mediated immune responses –> leads to cytotoxic effects –> then epithelial damage
clinical manifestations of behcet’s disease
recurrent oral ulcers (like RAS)
recurrent genital ulcers
occular inflammation
skin lesions
based on these 4 points – so 4 points system is used to describe this disease
primary infection HSV
prodromal symptoms
- fever, headache, malasie, nausea, vomitting
thin walled small vesicles–QUICKLY RUPTURE – shallow, round, discrete ulcers– large irregular painful ulcers of the lips and oral cavity (gingivostomatitis) – surrounded by an arythematous halo – heal spontaneously in 7-14 days
recurrent infections
of HSV 1 - prodromal period is 1 day with tingling, burning, swellling at the site of muccocutaenous junction of upper lip triangle zone beneath the nose –
cluster 1-2 cm of small vesicles of 1-3 mm
may or may not rupture to form shallow ulcers
heal in about 7 days
HHV 8
kaposi’s sarcoma
involved with immunosuppresion and HIV patients
HHV 8
kaposi’s sarcoma
involved with immunosuppresion and HIV patients
tx for HSV
acyclovir (zovirax) – for all members of herpes
- synthetic purine nucleoside specificall against human herpes virus
mechanism – highly selective – ONLY ACTIVE WHEN INFECTED
- viral thymidine kinase (contained in the virus)
the TK converts to active form – now active acyclovir triphosphate from which can be inorporated into growing chains of viral DNA, resulting in termination of viral DNA
terminates viral DNA
marginal gingiva is not affected in
pemphigoid
acyclovir work on latent?
no - does not elminate latent virus
acyclovir dependent on
renal excretion, thus the half-life is dependent on renal function
so risk of renal dysfunction in patients haing nephrotix agents
acyclovir dependent on
renal excretion, thus the half-life is dependent on renal function
so risk of renal dysfunction in patients haing nephrotix agents
contraindications for primary viral infections
use of corticosteroids – because it can cause immunosuppression
if get very severe infection then maybe but should not be getting these from you
Herpes zoster aja
shingles
primary infection of varicella zoster
chickenpox- varicella – occurs in susceptible children with no antibodies
become lifeling carriers - antibodies positive latent virus persist in ganglia of spinal nerves and cranial nerves
reactivation of varicella zoster
immunosuppression
trauma
local x ray radiation
malignancy of ganglia
reactivatino of v2 and v3 vs reactivation of herpes
herpes - bilateral distriubtion vs v2 / v3 - unilateral and segmental distribution with SHOOTING PAIN
shooting pain along the affected seneory of ____ nerves
prodromal period of herpes zoster
treatment for herpes zoster
acyclovir tablet
tx for immunocompromised for herpes zoster
acyclovir sodium intravenous solution (50 mg/ml) for immunocompromised cases
important in terms of treatment with acyclovir and herpes zoster
PROMPTNESS of tx within 72 hours of rash onset – may significantly influence the degree of beenfir from therapy
herpes zoster of v2 and 3?
oral and facial lesions - but HZ of V1 is more common
which is an acute lesion
erythema multiforme
definition of erythema multiforme
immune mediated acute inflammatory disease of the skin and mucosal membranes frequently in young adults and children
location of EM
involved lesions in SUPERFICIAL VESSELS
- this is where immune reaction is occuring
most common site of EM simplex
LIPS !!!
prominent and diagnostic site (NOT gingiva)
skin leison of EM looks
target or iris lesion - consisting of a central bulla or pale cleaning area surrounded by edema and bands of erythema OR
non specific macules, papules, and vesicles possibly containing petachiae in the center of the lesion
steven johnson syndrome
acute and generalized vesicles, bullae, erosive or denuded lesions involving skin, mouth, eyes, and genitals with prodromal symptoms of fever and malaise
tx for mild cases of EM
topical anesthetic mouthwashes - dexamethasone (decadron) elixir 0.5 mg/ 5 ml
prednisone
for severe cases of EM - this is a steroid
oral capsule that is ANTI-INFLAMMAOTRY AND SUPPRESSES T - CELL MEDIATED IMMUNE SYSTEM
use of prednison - basic
alternate day therapy or daily tx
daily therapy for prednisone
20-50 mg every morning 5-7 days
once a day morning before 8 am to limit the suppression of patients own immune
max function with be between 2pm- 8 am
give prednisone when for least side affect
before 8 am
alternative day therapy gives
least side effect if need to do this long term
40 mg to 100 mg every other day before 8 am for 5-7
following course with prednisone?
decrease the dose
so if did daily therapy of 20-40 decrease by 5 mg to 10 mg on each succesive day in the morning at 8 am
if did the alternate day therapy then decrease by 10 to 20 mg on every oter morning before 8 am
percautions of steroid use
have to know this
drug induced secondary adrenal suppresive effect (drug induced secondary adrenocortical insufficiency)
suppression of immune system –> more susceptible to infections
elevation of bp, salt and water retention, and increased excretion of postassium and calcium
peptic ulcer, impaired wound healing, menstrual irregularities
contact allergic stomatitis
this is NOT erythema multiform
this is a delayed type hypersensitivity reaction to TOPICAL ANTIGENS
etiology of contact allergic stomatitis
chewing gum, dental amalgam, gold crowns, acrylic denture, impression materials, toothpaste, benzocaine, etc
IgM
EM
type IV
delayed type hyerpsensitivity
IgG
definition of pemphigus vulgaris
autoimmune (IgG) involving the skin and oral mucosa with acantholysis and intraepithelial bullae formation in adults
diagnosis of contact allergic stomatitis
skin patch test (place suspected allergen on normal non hairy skin for 48 hours, examines for persistent erythema after 2-4 hours of allergen removal
where is mucous membrane pemphigoid
subepithelial
IgG target basement membrane
most signifivant presentnation of pemphigoid in oral
non-specific desquamative gingivitis
