Red lesions Flashcards
List what descriptors should be including when looking at a lesion
- Location
- A: Asymmetry
- B: Borders
- C: Colour
- D: Diameter
- E: Evolution
- F: Feeling (texture), firm, tethered, soft, raised? Flat? Blanchable? Fluid filled? Pus?
Associated features: palpable lymph nodes, fever, general pallor
Define fissure, erosion and ulcer
- Fissure: linear breaks within the skin surface
- Erosion: loss of part or all of the epidermis (the outer layer) leaving a denuded surface. The basement membrane is intact
- Ulcer: more extensive loss of the epidermis, including the basement membrane, with exposure of the underlying dermis
List 5 reasons why lesions are red
- Thinning or loss of epithelium
- Increased blood supply
- Vascular proliferation
- Inflammation
- Neoplastic changes
Describe how redness/ heat, swelling and pain occur in inflammation
- Redness/heat: Small blood vessels of injured tissues dilate. These vessels congest.
- Swelling: Increased permeability of local capillaries. Fluid seeps from blood vessels to tissue spaces, resulting in oedema.
- Pain: Swelling causes pressure on nerve endings. Release of bacterial toxins, prostaglandins, bradykinin, results in pain.
List the two main classifications of red lesions
Inflammatory (3 subcategories)
Non-inflammatory (3)
List the two main classifications of red lesions, and their respective subcategories
Inflammatory: Trauma • Chemical • Thermal • Radiation
Infection
• Chronic erythematous candidiasis
Immunological reactions
• Erosive lichen planus desquamative gingivitis
Non-inflammatory:
• Haematological vascular
• Nutrition
• Unknown: geographic tongue, erythroleukoplakia
For angular cheilitis:
- Describe it
- Aetiology (8)
- Management
Description:
• Chronic inflammatory lesion of the labial commissures (uni/bilateral)
• Appears as erythematous, fissured lesions at the angles of the mouth
Aetiology: • Folds/ wrinkles in skin • Reduced vertical occlusal height • Hypersecretion (saliva maceration) • Lip licking, biting habits • Hyposecretion (dry, cracking, desquamation) • Candida ssp. and Staphylococcus Aureus • Immune deficiency • Nutritional deficiency
Management: • Remove predisposing factors • Topical steroids • Topical antifungals • Topical antibiotics
For trauma:
- List the 3 main causes
- Describe it
- Management
List the 3 main causes: Physical/ Mechanical • Ill fitting dentures/ ortho appliances • Sharp cusps • Chronic habitual injury
Thermal
• Burn, usually food
Chemical
• Aspirin burn
Describe it:
• Brings about inflammation
• If no breach in mucosa, usually red patch
• Red area usually is source of irritation
Management:
• Asymptomatic
For denture stomatitis:
- Describe it
- List the 9 risk factors
- List the 4 signs/symptoms)
Description:
• Chronic inflammation, with erythema of the denture bearing surface of palate/ mucosa
Risk factors: • Institutionalised • Poor OH, reliant on other to clean • Immunosuppressed • Decreased motor function, • Poor overall health/nutrition • Xerostomia • Poor prosthesis • Smoking • Steroid
Signs and symptoms: • Bleeding of the affected areas of mucosa • Burning sensation • Halitosis, a bad taste • Xerostomia
For denture stomatitis:
• State the management (4)
• Describe allergies to denture materials
Management: • Manage underlying cause • Improve poorly fitted dentures • Improved denture hygiene • Use topical/ systemic antifungals
Allergies to denture materials:
• Rare
• Leads to a burning sensation, inflamed and oedematous mucosa, vesicle/blister, erosions, ulcers pain
• Remove inciting agent, antihistamine, +/-dexamethasone, provide alternative
Explain geographic tongue in terms of:
- What it is
- Description of its appearance
- Aetiology (2)
- Signs and symptoms (2)
What it is:
• Erythema migrans or benign migratory glossitis
Description of its appearance:
• Well demarcated red zones = atrophy of the filiform papillae partially or entirely surrounded by a slightly elevated white scalloped border
Aetiology:
• Hereditary/ environmental factors
• Females
Signs and symptoms:
• Asymptomaic or burning/ sensitivity to spicy foods
• Reassurance, no rx, avoidance foods, symptomatic relief
Explain median rhomboid glossitis
• Description of its appearance
• Aetiology (4)
• Signs and symptoms (4)
Description of its appearance:
• Well-demarcated, symmetric, de-papillated area arising anterior to the circumvallate papillae
Aetiology: • Smoking • Denture wearing • Diabetes mellitus • Candida
Signs and symptoms: • Most asymptomatic • Pain, irritation, or pruritus • Rx: control risk factors • Reported malignant transformation RARE
Explain kissing lesions in terms of
• Where it occurs
• Aetiology (2)
What it is
• Erythematous lesion that occurs on the palate
Aetiology:
• AIDS
• Some form of immunosupression
For erythroplakia, state
- Definition
- Detailed description (3)
- Risk factors (4)
- Places of occurrence (4)
- Management
Definition:
• Oral potentially malignant lesion, higher malignant potential than leukoplakia
• A fiery red patch that cannot be characterized clinically or pathologically as any other definable disease
Detailed description:
• Smooth or granular
• Velvety plaques
• Well-demarcated margins
Risk factors: • Smoking • Alcohol • Middle aged/ elderly • Male
Places of occurrence: • Floor of the mouth • Tongue • Soft palate • Buccal mucosa
Management:
• URGENT REFERAL + BIOPSY
• 70–90% of lesions exhibit carcinoma in situ and invasive squamous cell carcinoma
Discuss and describe plaque induced gingivitis
· Chronic inflammation localized to the gingiva
· Redness, edema, bleeding + swelling at the gingival margin, loss of gingival stippling
· Plaque induced, due to poor OH
· Tx: OHI and full mouth scaling and debridement
