Oral Path Exam 3 - Acute and Chronic Ulcerative Lesions Part 2 Flashcards
What lesion?
CD8+ T cells produce TNF-alpha (inflammatory cytokine)
Aphthous stomatitis (“canker sore”)
What lesion?
Trigger is different things for different people
Aphthous stomatitis (“canker sore”)
What lesion?
More frequent in kids and young adults
Aphthous stomatitis (“canker sore”)
What lesion?
Ulcer w/ yellow-white fibrinopurulent membrane, encircled by an erythematous halo
Aphthous stomatitis (“canker sore”)
What lesion?
Occurs on non-keratinized (moveable) mucosa
Aphthous stomatitis (“canker sore”)
What lesion?
Diagnosed clinically
Aphthous stomatitis (“canker sore”)
What lesion?
Histopathology is NOT diagnostic
Aphthous stomatitis (“canker sore”)
What lesion?
Heals without tx
Aphthous stomatitis (“canker sore”)
What lesion?
Recurrent cases = tx w/ topical steroid or steroid rinse
Aphthous stomatitis (“canker sore”)
What lesion?
Laser ablation shortens duration and decreases symptoms, but may not be practical in all cases
Aphthous stomatitis (“canker sore”)
What type of aphthous stomatitis (“canker sore”)?
Most common (80%)
Minor aphthous ulcers
What type of aphthous stomatitis (“canker sore”)?
Experience fewer recurrences
Minor aphthous ulcers
What type of aphthous stomatitis (“canker sore”)?
Shortest duration
Minor aphthous ulcers
What type of aphthous stomatitis (“canker sore”)?
Larger than minor aphthae
Major aphthous ulcers
What type of aphthous stomatitis (“canker sore”)?
Tend to be recurrent
Major aphthous ulcers
Herpetiform aphthous ulcers
What type of aphthous stomatitis (“canker sore”)?
Heal in 2-6 weeks
Major aphthous ulcers
What type of aphthous stomatitis (“canker sore”)?
Scarring can occur
Major aphthous ulcers
What type of aphthous stomatitis (“canker sore”)?
Tend to have multiple ulcers, but each ulcer is smaller than minor aphthae
Herpetiform aphthous ulcers
What type of aphthous stomatitis (“canker sore”)?
Heal in 7-10 days
Herpetiform aphthous ulcers
What lesion has the following reported causes?
Allergies
Genetic
Hematologic abnormalities
Hormonal influences
Immunologic factors
Infectious agents
Nutritional deficiencies
Smoking cessation
Stress (mental/physical)
Trauma
Aphthous stomatitis (“canker sore”)
What lesion has the following associated systemic disorders?
Behcet disease (genital + oral tissue)
Celiac disease
Cyclic neutropenia (ulcers occur repeatedly on 21-day cycle)
Crohn’s disease
Ulcerative colitis
Nutritional deficiencies
Recurrent aphthous stomatitis
What disease has the following oral manifestation?
Pyostomatitis vegetans
Inflammatory Bowel Disease (IBD)
What lesion?
Yellow-ish, slightly elevated, pustules on red oral mucosa
Pyostomatitis vegetans
What lesion?
Most common on buccal + labial mucosa, soft palate, and ventral tongue
Pyostomatitis vegetans
What lesion?
Snail track lesions, variably painful
Pyostomatitis vegetans
What disease has the following oral manifestations?
Aphthous ulcers
Cobblestone lesions
Linear ulcers/fissures in vestibule
Crohn’s disease
What lesion?
Allergy to food, food additive, chewing gum, candy, dentrifice, mouthwash, or dental materials
Allergic contact stomatitis
What lesion?
More common in females
Allergic contact stomatitis
What lesion?
Burning sensation
Allergic contact stomatitis
What lesion?
Erythema with or without edema
Allergic contact stomatitis
What lesion?
Superficial ulcerations may be present
Allergic contact stomatitis
What lesion?
Rarely, vesicles are seen
Allergic contact stomatitis
What lesion?
Temporal relationship btwn use of the agent and eruption
Allergic contact stomatitis
What lesion?
Patch testing may be useful in identifying allergen
Allergic contact stomatitis
What lesion?
Removal of allergen
Allergic contact stomatitis
What lesion?
Triggered by infection or medication
Erythema multiforme
What are the infectious triggers for erythema multiforme?
Mycoplasma pneumoniae (respiratory tract infections)
Herpes simplex virus 1 (HSV-1)
What are the medication triggers for erythema multiforme?
NSAIDs
Sulfonamides
Anti-seizure meds
Antibiotics
What lesion?
Avg age range is 20-40 yrs old
Erythema multiforme
What lesion?
Diffuse oral ulcerations
Erythema multiforme
What lesion?
Hemorrhagic crusting of lips
Erythema multiforme
What lesion?
Targetoid skin lesions
Erythema multiforme
What lesion?
Diagnosed by clinical history and presentation, bloodwork, or ID of a drug
Erythema multiforme
What lesion?
Bloodwork for mycoplasma pneumoniae and HSV-1 IgM antibodies
Erythema multiforme
What lesion?
Self-limiting (2-6 weeks)
Erythema multiforme
What lesion?
Caused by some form of injury (biting, neighboring sharp tooth, puncture, etc)
Traumatic ulcer
What lesion?
Affects a broad age range
Traumatic ulcer
Syphilis
What lesion?
Area of erythema around a central yellow fibrinopurulent membrane
Traumatic ulcer
What lesion?
May develop a rolled white border of hyperkeratosis adjacent to ulceration
Traumatic ulcer
What lesion?
Most common on tongue, lips, and buccal mucosa
Traumatic ulcer
What lesion?
If lesion persists beyond 2 weeks, biopsy to rule out squamous cell carcinoma
Traumatic ulcer
What lesion?
Tx = remove source of trauma, heals with time
Traumatic ulcer
What lesion?
Caused by treponema pallidum
Syphilis
What lesion?
Spread by direct contact w/ mucosal surfaces (sexual contact or mother to fetus)
Syphilis
What lesion?
3 stages of disease - primary, secondary, tertiary
Syphilis
What lesion?
Pts are highly infectious during the first 2 stages
What stage of syphilis?
Chancre
(solitary, papular lesion w/ central ulceration; 85% genital, 4% oral)
Primary syphilis
What stage of syphilis?
Regional lymphadenopathy
Primary syphilis
What stage of syphilis?
Symptoms resolve in a few days, even without tx
Primary syphilis
What stage of syphilis?
Disseminated
Secondary syphilis
What stage of syphilis?
Occurs 4-10 weeks after initial infection
Secondary syphilis
What stage of syphilis?
Systemic symptoms include:
Painless lymphadenopathy
Sore throat
Malaise
Headache
Weight loss
Fever
Secondary syphilis
What stage of syphilis?
Diffuse maculopapular cutaneous rash
Secondary syphilis
What stage of syphilis?
Split papule
(papule in the crease of the oral commissure)
Secondary syphilis
What stage of syphilis?
Mucous patch frequently on tongue, lip, buccal mucosa, and palate
(whitish, elevated plaque)
Secondary syphilis
What stage of syphilis?
Gumma
(indurated, nodular, or ulcerated lesion that causes extensive tissue destruction; affects palate or tongue)
Tertiary syphilis
What stage of syphilis?
Affects vascular system and CNS
Tertiary syphilis
What stage of syphilis?
Can result in paralysis, psychosis, dementia, and death
Tertiary syphilis
What lesion?
Oral manifestations of this disease can mimic many other conditions
Syphilis
What lesion?
Diagnosed by biopsy and blood tests
Syphilis
What lesion?
Blood tests include:
Venereal Disease Research Lab (VDRL)
Rapid Plasma Reagin (RPR)
Syphilis
How long can results from blood tests for syphilis be negative after initial infection?
Up to 6 weeks after initial infection
What lesion?
Tx = antibiotics (penicillin)
Syphilis
What lesion?
Caused by autoantibodies against hemidesmosomes and components of basement membrane
Mucous membrane pemphigoid
What lesion?
Affects older adults ages 50-60 yrs old
Mucous membrane pemphigoid
What lesion?
Vesicles or bullae present
Mucous membrane pemphigoid
What lesion?
Large areas of ulcerated/denuded mucosa
Mucous membrane pemphigoid
What lesion?
Can be limited to gingiva (desquamative gingivitis)
Mucous membrane pemphigoid
What lesion?
Can involve skin and conjunctival, nasal, esophageal, laryngeal, and vaginal mucosa
Mucous membrane pemphigoid
What lesions?
Positive Nikolsky sign
Mucous membrane pemphigoid
Pemphigus Vulgaris
Firm lateral pressure on intact mucosa causes epithelial separation
Positive Nikolsky sign
Seen in mucous membrane pemphigoid and pemphigus vulgaris
Positive Nikolsky sign
What lesion?
Symblepharon formation from conjunctival involvement can lead to blindness
Mucous membrane pemphigoid
What lesion?
Must make ophthalmology referral for all pts with this disease
Mucous membrane pemphigoid
What lesion?
Diagnosed by 2 perilesional biopsies:
1 in formalin -> subepithelial clefting
1 in Michel’s solution for direct immunofluorescence -> linear band of immunoreactants at basement membrane zone
Mucous membrane pemphigoid
What lesions?
Should be managed by a clinician experienced with treating this condition
Mucous membrane pemphigoid
Pemphigus vulgaris
What lesions?
Tx = varying combos of topical and systemic therapy, usually including steroids and immunosuppressive agents
Mucous membrane pemphigoid
Pemphigus vulgaris
What lesion?
Tx = refer to ophthalmologist
Mucous membrane pemphigoid
What lesion?
Caused by autoantibodies against components of desmosomes
Pemphigus vulgaris
What lesion?
Affects middle-aged adults
Pemphigus vulgaris
What lesion?
Ulceration of any oral mucosal surface, predilection for palate
Pemphigus vulgaris
What lesion?
May present w/ desquamative gingitivits
Pemphigus vulgaris
What lesion?
May have skin involvement
Pemphigus vulgaris
What lesion?
Diagnosed by 2 perilesional biopsies:
1 in formalin -> intraepithelial clefting
1 in Michel’s solution for direct immunofluorescence -> immunoreactants deposited in intracellular areas (chicken wire pattern)
Pemphigus vulgaris
What is the differential diagnosis when you see desquamative gingivitis?
Lichen planus (erosive or atrophic)
Pemphigus vulgaris
Mucous membrane pemphigoid
Allergy (dentrifice, preservatives, cinnamon, etc)
What lesion?
Immune mediated, specifically autoimmune
Mucous membrane pemphigoid
Pemphigus vulgaris
Connections btwn a cell
(both connections are to a cell)
Desmosomes
(think: pemphigus vulgaris)
One connection to the basement membrane, one connection to a cell
Hemidesmosomes
(think: mucous membrane pemphigoid)
