oral med - vesicullobulous

Question 1

describe pemphigus/pemphigoid to a patient

Answer 1

rare disease seeing blistering or ulceration of mouth and other mucous membranes e.g nose, eyes and genitals (skin may also be affected in pemphigus)
autoimmune disease meaning antibodies (natural defence cells in body) mistakenly attack surface layer of mouth resulting in blisters that then ulcerate

Question 2

symptoms of pemphigus

Answer 2

other mucosal areas affected - skin involvement also possible
irregular erosions (blisters burst quickly)
Pain
desquamative gingivitis

Question 3

how is pemphigus/pemphigoid diagnosed

Answer 3

perilesional incisional biopsy for histopathological analysis

Question 4

specialist treatment for pemphigus/ pemphigoid

Answer 4

• steroid drug treatment - e.g prednisolone

If mild - topical corticosteroids, CHX MW and analgesia

Question 5

symptoms of pemphigoid

Answer 5

blisters that may break down to form ulcers
pain
desquamative gingivitis

Question 6

characteristic sign of erythema multiforme

Answer 6

crusting and ulceration of lips
target lesions on skin

(acute onset, self limiting condition)

Question 7

treatment of erythema multiforme in mouth

Answer 7

GDP: refer to oral med for advice, difflam spray, corticosteroid MW

OM - systemic steroids (prednisolone), aciclovir if recurring

Question 8

describe lichen planus to a patient

Answer 8

inflammatory condition affecting the skin and /or mucous membranes
Cause is unknown
most commonly affects lining of cheeks (buccal mucosa)

Question 9

symptoms of lichen planus

Answer 9

raised itchy purple patches around wrist
bilateral and often symmetrical lesions in mouth

palate is almost always spared - if palate affected consider SLE

Question 10

cancer risk of oral lichen planus

Answer 10

1% risk over a 10 year period

Question 11

management of oral lichen planus

Answer 11

biopsy to confirm diagnosis
Mild cases with no symptoms may not require tx, tx invovles symptomatic relief
1. HSMW
2. avoid triggers - spicy and acidic foods, SLS toothpaste
3. analgesics - difflam spray , lidocaine ointments
4. topical corticosteroids - betamethasone MW or beclometasone MDI

severe cases - hospital - topical tacrolimus ointment or hydroxychloroquine

Question 12

4 things implicated in oral lichenoid reactions

Answer 12

amalgam
anti hypertensives
anti malarials
NSAIDs

Question 13

cause of erythema multiforme

Answer 13

hypersensitivity reaction