ORAL PATH ulcerated lesions Flashcards
what is an ulcer?
localised surface defect with loss of epithelium exposing underlying inflamed connective tissue
what are the causes of ulcers?
infection
trauma
drugs
idiopathic
systemic disease
dermatological disease
neoplasm
what viral infections are associated with oral ulceration?
HSV
VZV
CMZ
Coxsackie
what are types of trauma that may cause oral ulceration?
mechanical
chemical
thermal
factitious injury
radiation
give examples of drugs that cause oral ulceration
nicorandil
NSAIDs
what type of oral ulceration is idiopathic?
recurrent aphthous stomatitis
what systemic diseases are associated with oral ulceration?
haematological disease
GI disease
HIV
what dermatological diseases are associated with oral ulceration?
lichen planus
discoid lupus erythematosus
immunobullous disease
what oral ulcerations are neoplastic?
oral SCC
salivary gland neoplasms or metastases
what do a large proportion of ulcers show histopathologically?
non-specific features such as loss of surface epithelium, inflamed fibrinoid exudate and inflamed granulation tissue
what is a vesicle?
small blister < 10mm
what is a bulla?
blister >10mm
why do vesiculobullous lesions occur?
rupture of vesicles/ bullae
what are immunobullous disorders?
autoimmune diseases in which autoantibodies against components of skin and mucosa produce blisters
how would you histologically classify disorders which result in vesicles/ bullae?
classify depending on the location of the bulla:
1. intraepithelial
2. subepithelial
what are the 2 classifications of intraepithelial vesiculobullous lesions?
non-acantholytic (death and rupture of cells)
acantholytic (desmosomal breakdown)
give examples of intraepithelial non acantholytic vesiculobullous lesions?
HSV in primary herpetic stomatitis and herpes labialis
give examples of intraepithelial acantholytic vesiculobullous lesions
pemphigus: vulgaris, drug-induced and paraneoplastic types
what is the most common and most severe type of pemphigus?
vulgaris
what type of patients does pemphigus vulgaris frequently show in?
females 40-60 years
cause of pemphigus vulgaris?
autoantibodies to desmosomal protein (desmoglein 1 or 3) produced
treatment for pemphigus vulgaris?
steroids
how is pemphigus vulgaris and mucous membrane pemphigoid diagnosed?
direct immunofluorescence (DIF) studies used in conjunction with routine histopathology to confirm diagnosis - fresh specimen is mandatory for DIF
Explain how direct immunofluorescence diagnoses pemphigus vulgaris?
antibody to IgG attaches to pts autoantibody which is present around prickle cells as it is attacking the desmosomal proteins
what are examples of subepithelial vesiculobullous lesions?
pemphigoid
erythema multiforme
dermatitis herpetiformis
epidermolysis bullosa acquisita
what is pemphigoid?
a group of autoimmune diseases?
types of pemphigoid?
bullous pemphigoid
mucous membrane pemphigoid
linear IgA disease
drug-induced pemphigoid
what patients does mucous membrane pemphigoid usually present in?
females aged 50-80
what sites are affected by mucous membrane pemphigoid?
gingiva, buccal mucosa, tongue, palate
what do mucous membrane pemphigoid lesions present as?
desquamative gingivitis
apart from oral mucosa, what sites are also affected by mucous membrane pemphigoid?
eyes, nose, larynx, pharynx, oesophagus, genitalia
describe the bullae of mucous membrane pemphigoid?
tend to be relatively tough - full thickness epithelium
when they rupture they heal slowly with scarring
ocular lesions can lead to blindness
what is the treatment for mucous membrane pemphigoid?
steroids
what is epidermolysis bullosa acquisita?
an uncommon acquired autoimmune blistering dermatosis with subepithelial bullae
how does epidermolysis bullosa acquisita present?
oral lesions in 50% cases
early stage may mimic pemphigoid and later resembles epidermolysis bullosa
presents as desquamative gingivitis
what is epidermolysis bullosa?
group of rare genetic conditions in which skin bullae form and heal with scarring
what are the 3 variants of epidermolysis bullosa?
simplex
junctional
dystrophic
how does epidermolysis bullosa present?
blistering and erosion of lips
what is angina bullosa haemorrhagica?
oral blood blisters
where are oral blood blisters commonly found?
soft palate