Mucocutaneous Disease Flashcards
What is a lichenoid reaction and its aetiology?
= clinically + histologically similar to LP
A:
1. Drug induced
2. Dental materials
3. Idiopathic
State the clinical presentation of lichenoid reactions?
1) Unilateral or bilateral (often unilateral/asymmetric if reaction induced by local materials)
2) Can be ulcerative
3) Soreness as in LP (esp. erosive form)
4) Resolves on stopping of drug
State 10 drugs a/w lichenoid reactions?
1. Beta blockers (lol)
2. Ace inhibitors (pril)
3. Diuretics (semide/thiazide)
4. Hypoglycaemics (ide)
5. NSAIDS (Naproxen, Aspirin, Celecoxib, Ibruprofren, Diclofenac ~NACID)
6. Anti-malarials
7. Penicillamine (RA tx)
8. Gold salts (RA tx)
9. Allopurinol (Gout tx)
10. Methyldopa (hypertension tx)
State all key facts about oral contact hypersensitivity reactions to dental materials:
= A subgroup of oral lichenoid reactions
- Individual sensitised to a component of dental material:
o Amalgam alloy (nickel, mercury), gold, bis-GMA (resin).
- Lesion is confined to area of mucosa in direct contact with restoration
Amalgam contact hypersensitivity reactions (ACHRs):
o Lichenoid lesion localised to area of amalgam contact.
o Individual is patch test positive to ‘amalgam component’.
o Amalgam should be removed under rubber dam + restored with ‘inert’ material.
State management (i.e. diagnosis + tx) of lichenoid reactions:
Diagnosis:
1. Careful drug history and establish time relationship with starting the drug and appearance of lesions. (resolution once drug withdrawn)
- Consider patch testing if local causes
- Histological sample + analysis
Tx: Resolution of lesions should occur with withdrawal of drug.
Management as for LP until it resolves.
What would a histopathology report for a lichenoid reaction state? (5)
(remember similar to LP; hard to distinguish from histology)
LIP CB
o Infiltrate deeper + less well defined
o Large number of plasma cells + eosinophils (allergic reactions)
o Perivascular infiltrate
o Colloid bodies in the epithelium
o Basal cell destruction + basal cell autoantibodies
What is SLE and DLE?
SLE = systemic lupus erythematosus, while DLE= discoid lupus erythematosus.
Both are types of LUPUS, an autoimmune disease that causes inflammation.
SLE= affects many organs (multi-system disease that affects vascular + connective tissues).
DLE= mainly affects the skin
What is lupus? (general definition)
chronic cutaneous + oral disorder resulting in scaly skin patches in sun
exposed areas + lichen planus like oral lesions.
Who does lupus affect?
- Adults (women childbearing age)
- F>M
- 20-50% cases present with oral lesions
What is the aetiology of lupus?
Autoimmune disorder, precipitated by:
o Drugs
o Environment
o Hormones
o Viral factors
* Autoantibodies against normal cellular components e.g. nuclei
What is the oral presentation of lupus?
- Lesions occur BILATERALLY on labial, buccal, or alveolar mucosa + vermillion border (lesions on palate rarely seen)
-
Erythematous areas surrounded by border of fine white striae(less well-
demarcated than OLP but similar) - Lesions ulcerate (active cases/ in those that are developing SLE)
What cutaneous features can be observed in Lupus?
- Found in areas of exposed to sunlight.
- One or more oval plaques appear on face, scalp, or hands.
- Lesions well demarcated, red, atrophic, scaly, and show keratin plugs in dilated follicles, generalised telangiectasia.
- Scarring results in alopecia on scalp and pigmentation
What is the management (diagnosis + tx) of Lupus?
Diagnosis:
1. Biopsy
2. Autoantibodies (blood test)
Post biopsy, what would the histopathology show for Lupus diagnosis?
Histology shows:
o Parakeratosis or orthokeratosis
o Degeneration of basal layer
o Hyalinization of sub epithelial connective tissue
o Chronic inflammatory cell infiltration of the sub epithelial connective tissue!
o Irregular pattern of acanthosis
o Colloid bodies present!
o Keratotic plugging present!
What is Chronic Graft Versus Host Disease? (cGVHD)
= Complication following allogeneic bone marrow transplantation within 6-24m of BMT
- Involves immunological reaction of graft lymphocytes against recipient host cells
Who is affected by GVHD?
- Older recipients w/ poorly matched grafts
What is the clinical presentation of GVHD? (including oral)
- Involves eyes, mouth, skin + liver
- Burning oral discomfort/ asymptomatic
- If lesions present can be reticular, erosive, or ulcerative
- Oral dryness may follow salivary gland involvement (superficial palatal + labial mucoceles)
- Reduced oral opening post development of sclerotic form of cGVHD
State tx for GVHD:
Topical analgesic- lidocaine, benzydamine
Corticosteroid preparations- betamethasone m/w
Tracolimus ointment
Note: sig. increased risk of OSCC development - regular specialist monitoring! (as part of tx plan)
What is a Mucocutaneous disease?
Mucocutaneous diseases are conditions that affect the mucous membranes and skin
What is the definition of Lichen Planus?
- chronic inflammatory condition that affects mucous membranes inside your mouth
-premalignant condition - spectrum of oral, cutaneous, + genital disease
Who does Lichen Planus affect?
40-80 years old
F>M
Can affect children
Europeans, Indians, Chinese, Malay
What is the aetiology of Lichen Planus?
Immunologically mediated reaction where cytotoxic T cells target basal keratinocytes (autoimmune)
Idiopathic disease triggered by stress, spiced foods, T2DM, liver disease (related)
What is the IO presentation of Lichen Planus? (for varied time ~mean= 7yrs)
Where? buccal/ labial mucosa, tongue, gingiva (very rarely palatal or lingual)
Lesions often in areas of increased friction = Koebner phenomenon e.g. occlusal line
OFTEN SYMMETRICAL/ mirror image presentation (BILATERAL)
Asymptomatic
Pain/discomfort when eating spicy/acidic/citrus foods or when brushing teeth
Desquamative gingivitis
(Pt might be concerned re appearance if gingiva + lips involved!)
(CHECK DRUG HISTORY ALWAYS)
What are the 7 different morphological variants/ presentations of lichen planus?
PAPREBC
Papular
Atrophic (areas of erythematous lesion surrounded by reticular components)
Plaque-like
Reticular (fine white striae cross each other in the lesion)
Erosive (ulcerative)
Bullous
Circinate
–> can present w/ several forms at once/variants can coexist
