ORAL PATH ulcerated lesions

Question 1

what is an ulcer?

Answer 1

localised surface defect with loss of epithelium exposing underlying inflamed connective tissue

Question 2

what are the causes of ulcers?

Answer 2

infection
trauma
drugs
idiopathic
systemic disease
dermatological disease
neoplasm

Question 3

what viral infections are associated with oral ulceration?

Answer 3

HSV
VZV
CMZ
Coxsackie

Question 4

what are types of trauma that may cause oral ulceration?

Answer 4

mechanical
chemical
thermal
factitious injury
radiation

Question 5

give examples of drugs that cause oral ulceration

Answer 5

nicorandil
NSAIDs

Question 6

what type of oral ulceration is idiopathic?

Answer 6

recurrent aphthous stomatitis

Question 7

what systemic diseases are associated with oral ulceration?

Answer 7

haematological disease
GI disease
HIV

Question 8

what dermatological diseases are associated with oral ulceration?

Answer 8

lichen planus
discoid lupus erythematosus
immunobullous disease

Question 9

what oral ulcerations are neoplastic?

Answer 9

oral SCC
salivary gland neoplasms or metastases

Question 10

what do a large proportion of ulcers show histopathologically?

Answer 10

non-specific features such as loss of surface epithelium, inflamed fibrinoid exudate and inflamed granulation tissue

Question 11

what is a vesicle?

Answer 11

small blister < 10mm

Question 12

what is a bulla?

Answer 12

blister >10mm

Question 13

why do vesiculobullous lesions occur?

Answer 13

rupture of vesicles/ bullae

Question 14

what are immunobullous disorders?

Answer 14

autoimmune diseases in which autoantibodies against components of skin and mucosa produce blisters

Question 15

how would you histologically classify disorders which result in vesicles/ bullae?

Answer 15

classify depending on the location of the bulla:
1. intraepithelial
2. subepithelial

Question 16

what are the 2 classifications of intraepithelial vesiculobullous lesions?

Answer 16

non-acantholytic (death and rupture of cells)
acantholytic (desmosomal breakdown)

Question 17

give examples of intraepithelial non acantholytic vesiculobullous lesions?

Answer 17

HSV in primary herpetic stomatitis and herpes labialis

Question 18

give examples of intraepithelial acantholytic vesiculobullous lesions

Answer 18

pemphigus: vulgaris, drug-induced and paraneoplastic types

Question 19

what is the most common and most severe type of pemphigus?

Answer 19

vulgaris

Question 20

what type of patients does pemphigus vulgaris frequently show in?

Answer 20

females 40-60 years

Question 21

cause of pemphigus vulgaris?

Answer 21

autoantibodies to desmosomal protein (desmoglein 1 or 3) produced

Question 22

treatment for pemphigus vulgaris?

Answer 22

steroids

Question 23

how is pemphigus vulgaris and mucous membrane pemphigoid diagnosed?

Answer 23

direct immunofluorescence (DIF) studies used in conjunction with routine histopathology to confirm diagnosis - fresh specimen is mandatory for DIF

Question 24

Explain how direct immunofluorescence diagnoses pemphigus vulgaris?

Answer 24

antibody to IgG attaches to pts autoantibody which is present around prickle cells as it is attacking the desmosomal proteins

Question 25

what are examples of subepithelial vesiculobullous lesions?

Answer 25

pemphigoid erythema multiforme dermatitis herpetiformis epidermolysis bullosa acquisita

Question 26

what is pemphigoid?

Answer 26

a group of autoimmune diseases?

Question 27

types of pemphigoid?

Answer 27

bullous pemphigoid mucous membrane pemphigoid linear IgA disease drug-induced pemphigoid

Question 28

what patients does mucous membrane pemphigoid usually present in?

Answer 28

females aged 50-80

Question 29

what sites are affected by mucous membrane pemphigoid?

Answer 29

gingiva, buccal mucosa, tongue, palate

Question 30

what do mucous membrane pemphigoid lesions present as?

Answer 30

desquamative gingivitis

Question 31

apart from oral mucosa, what sites are also affected by mucous membrane pemphigoid?

Answer 31

eyes, nose, larynx, pharynx, oesophagus, genitalia

Question 32

describe the bullae of mucous membrane pemphigoid?

Answer 32

tend to be relatively tough - full thickness epithelium when they rupture they heal slowly with scarring ocular lesions can lead to blindness

Question 33

what is the treatment for mucous membrane pemphigoid?

Answer 33

steroids

Question 34

what is epidermolysis bullosa acquisita?

Answer 34

an uncommon acquired autoimmune blistering dermatosis with subepithelial bullae

Question 35

how does epidermolysis bullosa acquisita present?

Answer 35

oral lesions in 50% cases early stage may mimic pemphigoid and later resembles epidermolysis bullosa presents as desquamative gingivitis

Question 36

what is epidermolysis bullosa?

Answer 36

group of rare genetic conditions in which skin bullae form and heal with scarring

Question 37

what are the 3 variants of epidermolysis bullosa?

Answer 37

simplex junctional dystrophic

Question 38

how does epidermolysis bullosa present?

Answer 38

blistering and erosion of lips

Question 39

what is angina bullosa haemorrhagica?

Answer 39

oral blood blisters

Question 40

where are oral blood blisters commonly found?

Answer 40

soft palate