red lesions Flashcards
t/f. a vesicle can turn into an ulceration
true. but you cant go from an ulceration to a vesicle
t/f. there is no lymphadenopathy with AI diseases
true
epidermolysis bullosa
congenital defect in the attachment mechanisms of the epithelial cells
tx of epidermolysis bullosa
no cure, management: supportive (avoid trauma)
types of lesions in epidermolysis bullosa
vesicles and bullae due to minor trauma and oral lesion
t/f. viral diseases typically have slow onset
false. actue (fast)
features of viral diseases
lymphadenopathy (not in recurrent herpes or zoster), ulcers, vesicle stage (except mono)
HHV1
herpes simplex 1
typically infects oral region
HHV2
herpes simplex 2
typically infects genital region
herpes simplex oral cavity “history”
primary: exposure, often asymptomatic, but if symptomatic: gingivostomatosis
latency period
recurrent: epithelium supplied by sensory ganglion, usually symptomatic, asymptomatic viral shedding
primary herpetic gingivostomatosis
lymphadenopathy with multiple sesicles and ulcers anywhere in the oral cavity
may present subclinical
primary herpes features
pinhead vesicles develop, central ulcerations, yellow fibrin may coalesce into larger ulcers, involves keratinized and nonkeratinized mucosa
tx for primary herpes
acyclovir (zovirax) antiviral: adults - 200mg
resolves in 10-14 days
recurrent herpes simplex prodrome (early symptoms)
tingling, burning, paresthesia
recurrent herpes features of vesicles and ulcers
small clusters, perioral skin and keratinized oral mucosal surfaces, recur in the same location each time
t/f lymphadenopathy is present in recurrent herpes
false. it is not present
t/f. primary herpes only occurs on keratinized tissue
false. keratinized and non keratinized. recurrent is only keratinized
tzank cell
free floating epithelial cells
tx for recurrent herpes
effective at prodrome: valacyclovir (valtrex) (Rx)
prophylactic maintenance for recurrent herpes
acyclovir
t/f. zoster represents a recurrence
true. shingles is a recurrence of varicella (chickenpox)
t/f zoster only manifests at the terminal end of a nerve
false. the entire length of the nerve (shingles=dermatomes)
t/f. shingles is usually unilateral
true. follows the peripheral nerve distribution
post herpatic nerualgia
chronic severe pain in nerve distribution after zoster lesions resolve
HHV4
EBV (epstein-barr)/ infection mononucleosis
ebv is also associated with these 3 diseases
burkitts lymphoma, nasopharyngeal carcinoma, hairy leukoplakia
lab features of ebv
leukocytosis, lymphocytosis with atypical T cells, positive serology
oral mucosa features of ebv
erythmatous, petechiae on palate, ulcers without vesicles
etiology of hand foot and mouth
coxsackie virus group A
hand foot and mouth lesions
vesicles and ulcers throughout oral cavity
macules and vesicles on hands and feet
etiology of herpangina
coxsackie virus group A
herpangina lesions
vesicales and ulcers on posterior oral cavity: soft palate, uvula, tonsillar pillar
what virus family is measles in?
paramyxo (RNA)
how does measles spread
respiratory droplets
kopliks spots
erythmatous mucosal spots annd small blue/white macules in measles that looks like grains of salt
onset of AI diseases
gradual: weeks to months
progressive
t/f. AI diseases cant be cured but can be controlled with corticosteroids
true
t/f lymphadenopathy is present in AI diseases
FALSE
tx for non-microbial mucositis
topical: dexamethasone, triamcinolone acetonide
systemic: prednisone
intralesional: trimcinolone acetonide (inject 10-40 mg)
prednisone tx for non-microbial mucositis
30-60mg A.M.a for 5 days followed by 20mg AM QOD
cause of erosive lichen planus
immune abnormality involving T lymphocytes
lichenoid drug rxns
GvH rxns
features of erosive lichen planus
erythmatous ulcers with white striae along periphery
vesicles are rare
bilateral; focal or generalized
etiology of pemphigus vulgaris
autoabs to intercelluar protein in desmosomes
features of pemphigus vulgaris
fragile blisters that rupture easily, multifocal
nikolsky sign
able to induce an ulceration by touching or blowing air on it
sometimes presents in pemphigus vulgaris
microscopic features of pemphigus vulgaris
tzanck cells
direct immunofluorescence on biopsy
2 biopsy specimens needed for pemphigus vulgaris
1 submitted in formalin, the other in michels solution
tx for pemphigus vulgaris
corticosteroids:
dexamethasione, trimcinolone acetonide, prednisone
mucous membraine pemphigoid etiology
abs against basal lamina (hemidesmosomes) that attack the conjunctiva (eye)
where do pemphigoid lesions occur
conjunctiva (may cause blindness)
tx for mucous memb pemphigoid
corticosteroids:
dexamethasone, timcinolone acetonide, prednisone
etiology of bullous pemphigoid
autoabs against basal lamina
t/f bullous pemphigoid is the most common AI blistering condition
true
BP compared to MMP
BP more limited (skin) with NO scarring
SLE
multisystem diesase with increased activity of B cells and abnormal T cell function
CCLE
chronic cutaneous lupus erythematosus or “discoid lupus”
confined to skin and oral cavity
SCLE
subacute cutaneous lupus (intermediate lupus)
SLE effects what organs
kidneys (kidney failure)
heart (cardiac involvement)
CCLE features
scaley erythematous patches on skin, scarring and pigmentation
SCLE features
no scarring or pigmentations, renal changes absent with arthritis
chronic desquamative gingivitis presents as
diffuse sloughing of gingiva
acute erythematous candidosis features
most common form
generalized pain, burning and erythema
follows broad spectrum antibiotics
chronic erythematous candidiasis is seen in
denture wearers
“denture stomatitis”
t/f denture stomatitis may not be caused by candida
true
other features included in denture stomatitis
poorly fitting dentures, prolonged wearing of denture, poor hygiene
t/f angular chelitis typically occurs with reduced vdo but does not have to be
true. (saliva pools in the corner of the mouth)
microbes associated in angular chelitis
20% candida alone, 20% s. aureus alone, 60% candida and s. aureus
microbe causing syphilis
treponema palladium
primary phase of syphilis
chancre at site of innoculation, solitary lesion
secondary syphilis
cutaneous rash, condyloma lata
tertiary syphilis
cns and cv probs
hutchinsons triad
hutchinsons teeth, ocular intersitital keratitis, 8 nerve deafness
apthous ulcers have what kind of reaction
t-cell mediated immunologic rxn
canker sore
types of apthous ulcers
minor, major, and herpetiform
apthous ulcers are found on what type of tissue
non keratinized
features of minor apthous ulcers
size bt 3-10mm
heal in 1-2wks
no scarring
features of major apthous ulcers
size bt 1-3cm
heal up to 6 wks
more frequent recurrence
may cause scarring
features of herpetiform apthous ulceration
non keratinized (herpes in on keratinized)
size 1-3mm
heal in 7-10 days
microscopic features of apthous ulcers
cant see anything: biopsy is not diagnostic
diagnosis is based on history and clinical features
tx of apthous ulcers
mild: corticosteroids
major: more potent steroids
behcets syndrome
serious multisystem disease that consists of apthous like oral ulcers, genital ulcers, ocular inflammation, and skin pustules
erythema multiforme
acute onset
AI disease with unknown cause with blistering, ulcerative mucocutaneous condition
black necrotic tissue on lips
in 50% of cases, erythema multiforme is preceded by
herpes or pneumonia
forms of erythema multiforma
minor, major, and toxic epidermal necrolysis
features of erythema multiforme
ACUTE ONSET (key feature) target lesion (erythematous macule) diffuse painful oral ulcers
stevens johnson syndrome
more severe erythema multiforme with lesions that involve skin, conjunctiva, oral mucosa, and genital mucosa
granulomatosis with polyangiitis
granulomas around bvs
glomerulonephritis
systemic vasculitis
c-ANCA test
test for ab in Granulomatosis with polyangiitis
if a pt has chrons, what should you warn them of
ulcerations could also manifest in the mouth as well as the GI sys
erythroplasia/plakia
asymptomatic, persistent, red, or red/white lesion
not ulcerated
microscopically diagnosed
erythroplasia can be diagnosed as
dysplasia, carcinoma-in-situ, or superficial squamous cell carcinoma
what should you include in a differential with pemphigoid
pemphigus, erosive luchen planus, lupus, and erythema multiforme
how can you clinically differentiate erythema multiforme from pemphigus, pemphigoid, erosive lichen planus, lupus
erythema multiforme is acute onset
