MUCOCUTANEOUS DISEASES Flashcards
4 Mucocutaneous diseases
- LP
- lichenoid reaction
- DLE
- chronic graft vs bone disease
Lichen planus (what is it + location)
- chronic inflammatory condition
- immunologically mediated disease
- premalignant condition
- oral cutaneous genital (oral lesions are typically chronic)
- common 1-4% population
+ 70% of skin lesion pt have oral
10-30% of oral lesion pt have skin
coeliac disease exacerbates it
Lichen planus aetiology
- unknow
- immunologically mediated process
- cytotoxic t cells attack basal keratinocytes
- related to: stress, DM, spicy foods, liver disease (hepatitis C)
What questions do you ask someone with lichen planus
- ask about drug history
- is it painful?
- what makes it worse (spicy food/brushing teeth)
- onset, where is it most common
- are lips involved?
Oral presentation of lichen planus
- asymptomatic or pain with spicy food/brushing teeth
- common in: buccal labial mucosa and tongue
- rare: palate, FoM, lingual aspect
- forms: reticular(typical), erythematous (atrophic), ulcerative(erosive), plaque like, bullous, papular (initial presentation)/ circinate
- symmetrical/mirror image
- Often in areas of friction eg. Koebner phenomenon
- Associated with desquamative gingivitis
What is associated to desquamative ginvitis
LP
MMP
PV
DLE
Extra oral presentation of LP
-CUTANEOUS= on flexor surfaces (papules red turning violaceous)
+Wickhams striae
-HAIR= scarring alopecia, planopilaris
-NAILS= groovs+pits
-GENITAL= eg. ulcerative+ could be malignant
Lichen planus differentials
- lichenoid reaction
- DLE
- Leukoplakia
- candida infection
- epithelial dysplasia
- keratosis
- desquamative gingivitis= PV, MMP, DLE
- chronic graft vs bone disease
- white sponge naevus
- oral hairy leukoplakia
Lichen planus management (without drugs)
- Eliminiate provoking factors (eg. rough restoration)
- Reduce chemical irritation (acidic/alcohol)
- Reduce plaque accumulation due to desquamative gingivitis -OHI
- eliminate sodium lauryl sulfates
- smoking cessation+alcohol cessation
Lichen planus treatment (with drugs)
THIS IS NOT CURATIVE! it decreases pain and inflammation (controls symptoms)
- betamethasone 500mcg soluble tablet in 20 ml of water QDS for 5 days
- prednisolone
- Tacrolimus (0.03/0.1%) ointment -> calcineurin inhibitor = inhibits IL2 synthesis and t-cell activation = some studies have shown a cancer risk.
azathioprine/dapsone is steroids are not enough
Lichenoid reaction subgroups
- oral contact hypersensitivity reaction
- amalgam contact hypersensitivity reaction
Aetiology of lichenoid reaction
drug/dental materials causing hypersensitivity
Drugs linked to lichenoid reaction
b-blockets -elol ace-inhibitors -pril NSAIDs allopurinol anti-malarials hypoglycaemic agents
Oral presentation of lichenoid reaction
-indistinguishable to LP unless its unilateral/asymmetrical due to oral contact/amalgam hypersensitivity reaction
How to resolve lichenoid reaction
- withdraw drug
- remove dental material (always under rubber dam to prevent amalgam tattoo)
- manage lichen planus until this resolved eg. betamethasone
Discoid Lupus Erythematosus
- chronic cutaneous and oral disorder
- lichen planus like oral lesions
- scaly patches on sun exposed areas
Aetiology of DLE
- autoimmune disorder precipitated by drugs/hormone/environment/viral factors
- autoantibodies and cell mediated immunity against NORMAL cellular components eg. nuclei
DLE and lichen planus similarities and differences
similar to OLP and normally occur bilaterally
erythematous areas surrounded by wickhams striae
DIFFERENCES:
DLE is often seen on the palate and is rare in LP
Cutaneous DLE
- scaly patched in sun exposed areas
- generalised telangiectasia
- atrophic
- alopecia
Management of DLE (management= special investigation AND treatment)
SPECIAL INVESTIGATIONS
- Biopsy
- autoantibodies to normal cellular components like nuclei/cytoplasm
TREATMENT
-ORAL: treat oral lesions like OLP eg. betamethasone/prednisolone/tacrolimus (0.03-0.1%)
-SKIN: Chloroquine and topical corticosteroid (choloquine can cause blue-grey staining)
sun block spf 50
other drugs eg. dapsone
Chronic graft vs host disease
- complication following allogenic bone marrow transplant
- 6-24 months post BMT
- skin mouth eyes and liver are involved
- predisposing factors: poorly matched grafts + older
- successful grafts= grafts vs leukaemia effect
GVHdisease clinical features
ORAL: -reticular erosive ulcerative -burning mouth symptoms -xerostomia may follow salivary gland involvement -trismus due to sclerotic gvh disease you see it on the palate like DLE
Management of GVH disease
TREATMENT -analgesic eg. lignocaine/difflam 0.15% -topical corticosteroid betamethasone -tracolimus ointment 0.03-0.1% increase risk of OSCC so monitor
