Oral ulceration Flashcards
What is an ulcer?
Full thickness loss of epithelium where underlying CT can be observed and fibrin may be deposited
What are the main causes of ulcers?
Iatrogenic
- trauma heals in 2 weeks when agent is removed
Immunological
- RAU, LP, lupus, vesiculobullous disorders, erythema multiforme
Neoplasm
- carcinoma SCC
Infections
- bacterial, viral, fungal
Gastrointestinal
- crohns, UC, OFG
Drug related
- nicorandil: angina pectoris vasodilator drug
Why is nicorandil causing ulcers hard to diagnose?
They mimic SCC with deep punched out ulcers
What is the host factor causes of recurrent aphthae?
Genetic: HLA type 1 and 2
Nutritional deficiency: Iron, folate, B12
Systemic disease: chronic GI loss, dietary malabsorption, UC, crohns, menorrhagia
Endocrine: F>M remission in pregnancy
Immunosuppressants CD4:CD8 ratio
Higher CD8 ratio during ulcer stage
What are the potential environmental factors for recurrent aphthae?
Trauma Allergies Smoking Infections Stress
Minor aphthae diagnosis: Size Shape Number Histology Duration Outcome
Size: <10mm
Shape: round/oval with red halo and yellow base
Number: 1-20 per crop
Histology: chiefly non keratinising mucosa
Duration: heals within 1-2 weeks
Outcome: heals without scarring
More common in children
Major aphthae diagnosis: Size Shape Number Histology Duration Outcome
Size: >10mm Shape: oval/irregular Number: <5 or can occur singly Histology: keratinising or non keratinising mucosa (palate is common) Duration: heals within 6-12 weeks Outcome: heals with or without scarring
Herpetiform aphthae diagnosis: Size Shape Number Histology Duration Outcome
Size: <5mm Shape: round/ovale often coalesce into large areas of ulceration Number: 1-200 per crop Histology: non keratinising mucosa Duration: heals 1-2weeks Outcome: heals without scarring
How do you manage RAU?
Reassurance Correct underlying cause: - replace nutritional deficiency - treat systemic disease - remove traumatic agent - remove allergens
Medication: Topical immune modulation: - benzodamine numbing spray - betamethasone MW 0.5mg 2/3x per day - betamethasone inhaler 50ug 2/3x per day - CHX MW - hydrocortisone pellets
Systemic immune modulation:
- prednisolone systemic steroids
- azathioprine
- adalimumab
- thalidomide
What is Reiter’s syndrome?
It is a condition characterised by inflammatory arthritis that develops in response to an infection elsewhere in the body which then triggers this reaction.
It generally clears up in few months and affects mostly 20-40yr olds
What is the triad of symptoms of Reiter’s?
Inflammatory arthritis of the joints
Conjunctivitis/uveitis
Urethritis or cervicitis
What is the oral symptoms of Reiter’s?
Mucocutaenous lesions - Oral ulcers that come and go
RAS
Geographic tongue
Migratory stomatitis
How is Reiter’s treated?
Antibiotics to clear infection
Painkillers - NSAIDS
DMARDS for ongoing cases
What is Behcets syndrome?
It is a chronic auto-inflammatory condition associated with variety of health problems due to inflammation of the blood vessels.
In particular small vessels such as mouth, genitals, skin and eyes
What is the oral manifestations of Behcet’s?
Painful mouth ulcers on lip, tongue, inside of cheek, palate, throat and tonsils that heal within 1-2 weeks.
May have associated genital ulcers and sores on skin resembling acne.
