Lec 4: Red Lesions Flashcards
Vesicle vs. Ulcer
A vesicle may eventually lose the overlying epithelium and then present as an ulceration
EPIDERMOLYSIS BULLOSA defect in?
Defect in the attachment mechanisms of the epithelial cells
EPIDERMOLYSIS BULLOSA cure?
No cure
EPIDERMOLYSIS BULLOSA management?
supportive
EPIDERMOLYSIS BULLOSA–Vesicles and bullae due to?
minor trauma
EPIDERMOLYSIS BULLOSA–oral lesions? (2)
Bullae may heal with scarring; restricted opening
Hypoplastic teeth
VIRAL DISEASES onset?
acute
VIRAL DISEASES symptoms?
May have malaise, fever, lymphadenopathy
Lymphadenopathy not present with?
recurrent herpes and zoster
Viral diseases all have?
vesicle stage
Viral diseases multiple___
ulcers
Spread predominantly through infected saliva or active perioral lesions
Adapted best to the oral, facial and ocular areas
Developed nations show 20% exposure at age 5 and 50-60% at adulthood
Herpes simplex 1
Adapted best to genital zones
Transmitted through sexual contact, typically involving the genitalia
Herpes simplex 2
Primary infection? occurs at? symptomatic or asymptomatic?
Initial exposure of individual without antibodies to virus
Typically occurs at young age
Often asymptomatic or subclinical
Latency? most common?
Virus taken up by sensory nerves
Most common site for HSV-1 is trigeminal ganglion
Recurrent? affect the? usually symptomatic or asymptomatic?
Reactivation of the virus
Affect the epithelium supplied by sensory gangilion
Usually symptomatic
Primary Herpetic Gingivostomatitis
Lymphadenopathy present
Multiple vesicles and ulcers anywhere in oral cavity, pharynx, and perioral skin
May present subclinically
Primary Herpes
Numerous pinhead vesicles develop
Lesions enlarge slightly and develop central ulceration
In primary herpes, Sometimes yellow fibrin covers the ulcers, which may?
coalesce
Primary herpes involves
keratinized and non-keratinized mucosa
In Primary herpes, the gingiva is always enlarged and..
painful and extremely red
Primary Herpes treatment?
Acyclovir (Zovirax)
Adults: 200mg
resolves in 10-14 days
HERPES SIMPLEXRECURRENT HERPES aka
cold sore and fever blisters
Prodrome: tingling, burning, paresthesia
RECURRENT HERPES occur in? appears on?Lymphadenopathy present?
small clusters;
Appears on On vermilion border, perioral skin and keratinized oral mucosal surfaces; Recur in same location each time; NO
HERPETIC WHITLOW (HERPETIC PARONYCHIA): due to? common in what profession?
Due to self-innoculation in children. Used to be common in dentists before gloves.
HERPES GLADIATORUM (SCRUMPOX): common in
wrestlers and rugby players
CHRONIC HERPETIC INFECTION: seen in?
immunocompromised hosts
TZANCK CELL?
free floating epithelial cell
Recurrent Herpes treatment? (2)
Medication most effective if taken at prodrome
RX: Valacyclovir (Valtrex)
Rx: Acyclovir
HEREPES ZOSTER (SHINGLES)-zooster represents a?
recurrence
Herpes Zoster (Shingles)-unilateral or bilateral?
Unilateral distribution
Herpes Zoster (Shingles) follows peripheral?
nerve distribution
Herpes Zoster (Shingles)–prognosis?
Post-herpetic neuralgia: chronic severe pain in nerve distribution after lesions resolve
INFECTIOUS MONONUCLEOSIS etiology?
Epstein-Barr virus (EBV, HHV-4)
EBV also associated with:
Burkitt’s lymphoma
Nasopharyngeal carcinoma
Hairy leukoplakia
INFECTIOUS MONONUCLEOSIS– Laboratory features?
Leukocytosis
Lymphocytosis with atypical T lymphocytes
Positive serology
INFECTIOUS MONONUCLEOSIS–oral mucosa?
Erythematous
Petechiae on palate
Ulcers without vesicles, later in disease
HAND, FOOT AND MOUTH DISEASE etiololgy?
coxsackievirus, group A
HAND, FOOT AND MOUTH DISEASE lesions?
Vesicles and ulcers throughout oral cavity
Macules and vesicles on hands and feet
HERPANGINA etiology?
coxsackievirus, group A
HERPANGINA-lesions?
Similar to HFM, but confined to posterior oral cavity
Soft palate, uvula, tonsillar pillar
MEASLES (RUBEOLA)–Viral infection caused by a member of the?
paramyxovirus family
MEASLES (RUBEOLA)–spread through?
respiratory droplets
MEASLES (RUBEOLA)–appearance signs?
Koplik’s spots
“Grains of salt”
AUTOIMMUNE DISEASES onset? progressive? These diseases cannot be cured but can be?
Gradual onset: weeks to months; progressive; controlled with corticosteroids
Treatment of Non-Microbial Mucositis with Corticosteroids
Topical Steroids
Systemic Steroids
Intralesional Steroids
Treatment of Non-Microbial Mucositis with Corticosteroids–Topical Steroids?
Mouthrinse
Dexamethasone
Triamcinolone acetonide
Ointment
Treatment of Non-Microbial Mucositis with Corticosteroids–Systemic Steroids?
Prednisone: 30-60 mg A.M. x 5 days, followed by 5-20 mg A.M. QOD
Treatment of Non-Microbial Mucositis with Corticosteroids–Intralesional Steroids?
Triamcinolone acetonide, inject 10-40 mg
EROSIVE LICHEN PLANUS–cause?
Immune abnormality involving T lymphocytes
Lichenoid drug reactions
Graft-versus-host reactions
Erosive Lichen Planus: Oral Lesions–appearance? vesicles are? bilateral or unilateral?
white striae along periphery;
Vesicles are rare;
Bilateral; focal or generalized
PEMPHIGUS VULGARIS–etiology?
autoantibodies to intercellular protein in desmosomes
PEMPHIGUS VULGARIS–type of blisters?
Fragile blisters rupture easily forming painful ulcers
PEMPHIGUS VULGARIS-sign? Large areas of skin or mucosa involved; usually?
Nikolsky sign sometimes present; multifocal
Pemphigus Vulgaris-microscopic?
Tzanck cells
Direct immunofluorescence on biopsy
Pemphigus Vulgaris- 2 biopsy specimens needed?
1 submitted in formalin
1 submitted in Michels solution
_______ Vesicle In Pemphigus Vulgaris
Intraepithelial
Pemphigus Vulgaris and Mucous Membrane Pemphigoid–treatment?
Corticosteroids
Mouthrinse
Dexamethasone
Triamcinolone acetonide
Systemic
Prednisone: 30-60 mg A.M. x 5 days, followed by 5-20 mg A.M. QODMUCOUS MEMBRANE (CICATRICIAL) PEMPHIGOID and Bullous Pemphigoid etiology?
antibodies against basal lamina (hemidesmosomes)
MUCOUS MEMBRANE (CICATRICIAL) PEMPHIGOID extraoral lesions?
Conjunctiva: may cause blindness
Nasal, pharyngeal, vaginal mucosa
Skin
SYMBLEPHARON
Adhesion between the bulbar and palpebral conjunctivae. May lead to blindness.
DESQUAMATIVE GINGIVITIS:
diffuse gingival erythema
Most common auto-immune blistering condition
Bullous pemphigoid
Compared with MMP (Mucous Membrane Pemphigoid) vs. BP (Bullous pemphigoid)
BP more limited
No scarring with BP
LUPUS ERYTHEMATOSUS 3 types
Systemic lupus erythematosus (SLE)
Chronic cutaneous lupus erythematosus (CCLE)
Subacute cutaneous lupus erythematosus (SCLE)
Chronic cutaneous lupus erythematosus (CCLE) aka
Aka discoid lupus erythematosus
Chronic cutaneous lupus erythematosus (CCLE) confined to?
skin and oral cavity
Intermediate features between SLE and CCLE is what disease?
Subacute cutaneous lupus erythematosus (SCLE)
Systemic lupus–organ involvement?
May lead to kidney failure
Cardiac involvement also common
LIBMAN-SACKS ENDOCARDITIS:
warty vegetations affecting the heart valves. Found at autopsy in 50% of SLE patients
Chronic Cutaneous Lupus–limited to? symptoms?
skin or mucosal surfaces; Scaly, erythematous patches, Scarring and pigmentation
CHRONIC DESQUAMATIVE GINGIVITIS presents as
diffuse sloughing of gingiva
Riga-Fede disease?
ulcer on tongue of neonates due to trauma from erupting teeth
Most common oral fungal infection in humans
CANDIDOSIS
CANDIDOSIS agent?
Candida albicans
CANDIDOSIS?
Fungal infection on the surface of the mucosa
Acute Erythematous Candidosis-most common or rare? symptoms? typically follow?
Most common form (more common than pseudomembranous)
Generalized pain, burning and erythema
Typically follow broad-spectrum antibiotics (“antibiotic sore mouth”)
What diseases is commonly seen in denture wearers, aka denture stomatitis?
Chronic Erythematous Candidiasis
Denture stomatitis- causes?
poorly fitting dentures, prolonged wearing of denture, poor hygiene, (may not be caused by candida)
What disease typically occurs with reduced vertical dimension of occlusion, but does not have to be?
Angular Cheilitis
Syphilis caused by?
Treponema pallidum
Syphilis primary symptoms?
Chancre at site of inoculation
Solitary lesion, usually at genitalia
Syphilis secondary symptoms?
Maculo-papular cutaneous rash
Mucous patches
Condyloma lata
Syphilis tertiary symptoms?
CNS (neurosyphilis) and CV problems
Syphilis aka
Great imitator
Congenital Syphilis symptom?
Hutchinson’s triad
Hutchinson’s triad? (3)
Hutchinson’s teeth, ocular interstitial keratitis and eight nerve deafness
APHTHOUS ULCERS what immunologic reaction?
T-cell mediated immunologic reaction
APHTHOUS ULCERS types (3)
Minor, Major, and Herpetiform
APHTHOUS ULCERS on what type of mucosa?
non-keratinized mucosa
APHTHOUS ULCERS aka
canker sore
MINOR APTHOUS ULCERATION–size? healing time? scaring?
Size between 3-10 mm
Heal in 7-14 days
No scarring
MAJOR APTHOUS ULCERATION–sized? healing time? scaring?
Size between 1-3 cm
Healing in up to 6 wks
More frequent recurrence
May cause scarring
HERPETIFORM APTHOUS ULCERATION - size? healing time?
Size between 1-3 mm; may coalesce with one another
Heal in 7-10 days
Aphthous Ulcers-Microscopic features: Biopsy is not diagnostic. Diagnosis is based on history and clinical features. True or False?
True
APHTHOUS ULCERSTreatment for Mild and Major Aphthae ulcers?
Mild disease: topical corticosteroids
Major aphthae: more potent steroids
Aphthous Ulcers gives way to what syndrome?
Behcet’s Syndrome
Behcet’s Syndrome
Serious, multisystem disease
Aphthous-like oral ulcers, genital ulcers, ocular inflammation, skin pustules
ERYTHEMA MULTIFORME cause?
unknown
ERYTHEMA MULTIFORME predisposing factors?
In 50% of the cases, preceded by herpes or pneumonia
Medications: antibiotics, analgesics, sulfanomides
ERYTHEMA MULTIFORME forms (3)
minor, major and toxic epidermal necrolysis
ERYTHEMA MULTIFORME onset?
acute
ERYTHEMA MULTIFORME skin lesion feature?
“Iris” or “target” lesion: erythematous macule with central vesicle
ERYTHEMA MULTIFORME oral lesion features?
Diffuse painful ulcers: may have vesicles
Common lips, buccal and labial mucosa
Stevens-Johnson syndrome (EM major):
oral and skin lesions + ocular or genital
Toxic epidermal necrolysis (Lyell’s disease):
diffuse sloughing of skin
Erythema Multiforme key clinical feature?
lesions appear suddenly
Stevens-Johnson Syndrome:
A more severe form of erythema multiforme
Lesions involve skin, conjunctiva, oral mucosa, genital mucosa
Granulomatous lesions of the upper respiratory tract
Necrotizing glomerulonephritis
Systemic vasculitis of small arteries and veins
What disease?
GRANULOMATOSIS WITH POLYANGIITIS
Granulomatosis with Polyangiitis what test is done?
c-ANCA test
ERYTHROPLASIA symptoms?
Asymptomatic, persistent, red, or red/white lesion.
ERYTHROPLASIA is microscopically diagnosed as
epithelial dysplasia, carcinoma-in-situ, superficial squamous cell carcinoma
HHV1
Human Herpes Types 1 (HSV1)–Herpes simplex
HHV2
Human Herpes Types 2 (HSV2)-Herpes simplex
HHV3
Varicella Zoster Virus (VZV)
HHV4
Epstein-Barr Virus (EBV)
HHV5
Cytomegalovirus (CMV)
HHV6
Roseola virus
HHV7
Roseola-like virus
HHV8
Kaposi sarcoma herpes virus (KSHV)
Does recurrent herpes have lymphadenopathy?
NO
Is lymphadenopathy present in primary herpes?
YES
post-auricular lymphandenopathy
Infectious mononucleosis
Herpangia vs. herpes
Herpangia is only on the soft palate unlike herpes that is everywhere.
Measles is DNA or RNA virus?
RNA
Koplik’s spot refers to
Measles (Rubeola)
Do autoimmune disease have lymphandenopathy?
NO
Autoimmune vs. viral disease?
Unlike viral, autoimmune diseases keep getting worse and worse as time goes on.
Which attacks the eyes Pemphigoid or pemphigus?
Pemphigoid
Murberry molars and Hutchinson’s incisors are related to
syphilis
Primary herpes what time of tissue is it on?
keratinized AND non-keratinized
*must be both
Recurrent herpes tissue?
keratinized
Happens acutely onset?
erythema multiforme
Crohn’s disease-same ulcerations in colon can appear in the
mouth thus oral ulcerations
hemangioma aka
vascular malformation
