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Oral med > lichen Planus and oral vesicullobullous disease > Flashcards

lichen Planus and oral vesicullobullous disease Flashcards

1
Q

what areas of the body can lichen planus effect?

A
  • Skin
  • Scalp
  • Genital
  • Oesophageal
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2
Q

what is oral lichen planus (OLP)?

A

OLP is a cell mediated autoimmune condition which targets (oral) keratinocytes.

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3
Q

what causes OLP?

A

Mostly idiopathic however aetiological factors may be:

drugs (drug induced OLL)

mercury( amalgam associated OLL).

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4
Q

what is this?

A

signs of oral lichen planus

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5
Q

what are the intraoral features of OLP?

A

o Keratosis: reticular (web like) / annular(ring like) / plaque like keratosis may be present.

o Desquamative Gingivitis o Areas of atrophic

inflamed oral mucosa

o Mucosal erosion or even frank ulceration

o Bullous lesions.

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6
Q

what type of OLP is this?

A

Reticular

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7
Q

what does this show?

A

Lichenoid drug reaction

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8
Q

what are the potential complications of OLP?

A

Pain –quality of life, nutrition and oral hygiene measures

Periodontal attachment loss: this is an indirect effect when oral hygiene measures are compromised secondary to discomfort.

Malignancy risk: OLP is a potentially malignant lesion (transformation risk incidence of 1%)

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9
Q

what are the differential diagnosis of OLP?

A

GVHD, HCV, Lupus

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10
Q

what is GVHD?

A

Graft vs host disease. Where the graft which has been transplanted starts attacking the bodies own self tissues.

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11
Q

what is this

A

Presentation of GVHD but may present similarly to OLP

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12
Q

What is HCV?

A

Hep C. It may present similarly to OLP

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13
Q

what does this show?

A

Both Lupus and OLP present identically even histopathologically they both have lichenoid appearances

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14
Q

Incisional or punch biopsys are often taken of OLP. what would they show histopathologically?

A

evidence of basal membrane immune mediated damage

sub basal lymphocytic band

hyper/ hypokeratosis, although this may not be evident in ulcerated areas

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15
Q

what other investigations can be done to diagnose OLP?

A
  • DirectIF
  • Epidermal patch testing
  • HCV serology
  • Autoimmune profile
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16
Q

How do you manage OLP?

A

identify and eliminate the cause.

Remove amalgam if they are believed to be the cause

Drug lichnoid reactions- liase

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17
Q

What topical steroids could be use?

A

Betnasol mouthwash

Barrier agents such as orobase which is a carboxymethylcellulose or hyaluronic based preparations such as Gelclair or Gengigel.

Chlorhexidene

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18
Q

When should you refer?

A

In medium to severe cases which are unresponsive to first line therapy should be referred to an oral medicine specialist.

High Potency Topical Steroids such as Clobetasol Proprionate 0.05% ointment mixed on a 1:1 basis with Orabase

Topical Tacrolimus 0.01% ointment mixed on a 1:1 basis with Orabase

19
Q

what systemic therapy can be used for OLP?

A

Reducing course of Prednisolone eg.40 -30- 20-10 mgs reducing over a period of 1 month.

Long term Systemic Therapy for specialist use in recalcitrant OLP

20
Q

Should you review OLP?

A

Yes! Potentially malignant.

Need to involve other care teams if extra oral

21
Q

What are the two types of pemphigoid?

A

Bullous pemphigoid- usually just skin

Mucous membrane pemphigoid- Effects mucosa and +- skin

22
Q

what causes mmp?

A

t is an autoimmune disease with antibodies directed at antigen/s in epithelial basement membrane resulting in a split and blister formation at this level.

Specifically BP 180 at the basement membrane

23
Q

How does MMP present?

A

Desquamative gingivitis

Can be oral, pharyngeal and genital.

24
Q

what is this?

A

The presentation of MMP

25
Q

what are the intra oral findings with MMP?

A

Mucosal inflammation

Mucosal erosion and frank ulceration

Blister formation

Desquamative gingivitis

Scarring

26
Q

what does this histopathology slide show?

A

Pemphigoid ( blister at the basement membrane_

27
Q

what technique is this and what does it show?

A

Direct immunofluoresence

28
Q

how does indirect immunofluoresence differ from direct?

A

indirect uses a blood sample.

29
Q

what are the complications of mmp?

A

Skin involvement: blistering, ulceration

Genital involvement: blistering, ulceration and scarring leading deformities

Pharayngeal involvement: blistering, ulceration and scarring →stricture formation and dysphagia

Oral involvement: blistering, ulceration and periodontal tissue loss ( secondary to inability to maintain adequate oral hygiene)

30
Q

what are the complications of MMP in the eye?

A

Tethering of conjunctiva to sclera (symblepharon)

Inversion of eyelashes (entropion)

Scleral irritation and inflammation (blepharitis).

31
Q

what are the topical treatments for mmp?

A

topical steroid- dermovate

topical immunosuppressants

32
Q

what systemic treatment is given?

A

Steroids- prednisolone

sliding dose- ( decreases as time goes on)

33
Q

Give an example of a systemic immunosuppressant?

A

Mycophenolate Mofetil

Inhibits the synthesis of the purine nucleotide guanine

Inhibits the proliferation of B and T cells in response to antigen stimulation

34
Q

what is pemphigus vulgaris?

A

Autoimmune Disease

Antibody mediated

Target: desmosomal proteins(DSG1,3)

PV often starts with oral lesions with later skin involvement

Complications of disease and therapy

35
Q

what causes PV?

A

Antibodies are directed against:

– Desmoglein (DSG) 1(mainly expressed in oral mucosal desmosomes

– DSG 3 which is mainly expressed in skin desmosomes.

36
Q

what are the intraoral findings of PV?

A

– Mucosal erosion and frank ulceration even including hard and soft palate

– Blisters: typically burst

– Desquamative gingivitis

37
Q

what are the Extra oral findings of PV?

A

Skin lesions: Itchy erythematous

papules and blisters

» Genital lesions and soreness, scarring

» Pharyngeal lesions, possibly with scarring and dysphagia

38
Q

what does this slide show?

A

Pemphigus

39
Q

what does this direct immunoflouresence show?

A

pemphigus

40
Q

How do you treat and manage Pv?

A

Acute control: systemic & topical steroids

Maintenance-topical & systemic steroids & MMF/ Azathiaprine

mulitdisiplinary care!!

41
Q

what drugs can induce pemphigus oral ulceration?

A

induced by drugs with a sulphydryl group such as captopril

42
Q

what is paraneoplastic pemphigus?

A

the pemphigus related oral ulceration but with associated malignancy!

43
Q

what are the complications of PV?

A

Skin involvement: blistering, ulceration, fluid loss- shock – death.

Genital involvement: blistering, ulceration

Pharayngeal involvement: blistering, ulceration and

scarring.

Oral involvement: blistering, ulceration . Loss of periodontal tissues (secondary to inability to maintain adequate oral hygiene)

44
Q

what are the other vesiculobullousdisorders which have oral manifestations?

A
  • Dermatitis Herpetiformis
  • EpidermolysisBullosa Acquisita
  • ErythemaMultiforme
  • Viral infections can cause blisters !!

Oral med (18 decks)

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