Ulcerated lesions

Question 1

what is an ulcer

Answer 1

localised surface defect with loss of epithelium exposing underlying inflamed tissue

Question 2

causes of ulcers

Answer 2

infective
traumatic
drugs
idiopathic
associated with systemic or dermatological disease
neoplastic

Question 3

viruses that can cause ulceration

Answer 3

Herpes simplex virus
varicella zoster virus
cytomegalovirus
coxsackie

Question 4

drugs that can cause ulceration

Answer 4

nicorandil
NSAIDs

Question 5

idiopathic cause of ulceration

Answer 5

recurrent aphthous stomatitis

Question 6

ulceration associated with systemic disease

Answer 6

haematological disease
GI disease
HIV

Question 7

ulceration associated with dermatological disease

Answer 7

lichen planus
discoid lupus erythematosus
ummunobullous diseases

Question 8

neoplastic ulceration

Answer 8

oral squamous cell carcinoma

Question 9

what is a vesicle

Answer 9

small blister

Question 10

what is a bulla

Answer 10

blister over 10mm

Question 11

when does a vesiculobullous lesion usually present as oral ulceration

Answer 11

following rupture of vesicles/bullae

Question 12

what is a subset of lesions known as

Answer 12

immunobullous disorders

Question 13

how are disorders which result in vesicles/bullae classified

Answer 13

depending on the location of the bulla

Question 13

what are immunobullous disorders

Answer 13

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

Question 14

classification of disorders which result in vesicles/bullae

Answer 14

intraepithelial
sub epithelial

Question 15

subgroup of intraepithelial disorders which result in vesicles/bullae

Answer 15

non-acaztholytic (death and rupture of cells) e.g. viral infection
acantholytic (desmosomal breakdown)

Question 16

example of intraepithelial - non acantholytic virus

Answer 16

Herpes simplex virus

Question 17

example of intraepithelial - acantholytic lesion

Answer 17

pemphigus

Question 18

what is pemphigus

Answer 18

group of autoimmune diseases that affect the skin and mucous membranes

Question 19

pemphigus vulgarise what happens to bullae

Answer 19

bullae form in skin and mucous membranes then rupture to leave ulcers

Question 20

treatment of pemphigus vulgarisms

Answer 20

steroids

Question 21

Histopathology of pemphigus vulgaris

Answer 21

characteristic intraepithelial bullae produced by acantholysis

Question 22

what is used to confirm diagnosis of pemphigus vulgaris

Answer 22

direct immunofluorescence (DIF) in conjunction with routine histopathology

Question 23

what is mandatory for direct immunofluorescence

Answer 23

fresh specimen

Question 24

sub epithelial examples

Answer 24

pemphigoid erythema multiform dermatitis herpetiformis epidermolysis bulls acquisita

Question 25

groups of pemphigoid

Answer 25

bullous mucous membrane linear IgA disease drug induced

Question 26

where is usually the first affected site in mucous membrane pemphigoid

Answer 26

oral mucosa

Question 27

how do gingival lesions present as in mucous membrane pemphigoid

Answer 27

desquamative gingivitis

Question 28

how do bullae present in mucous membrane pemphigoid

Answer 28

tend to be relatively tough as the 'lid' is full thickness epithelium

Question 29

treatment of mucous membrane pemphigoid

Answer 29

steroids

Question 30

histopathology of mucous membrane pemphigoid

Answer 30

separation of full thickness epithelium from connective tissue producing subepithelial bulla with a thick roof

Question 31

what do you use to confirm diagnosis of mucous membrane pemphigoid

Answer 31

direct immunofluorescence (DIF) in conjunction with routine histopathology

Question 32

what is epidermolysis bulls acquisita

Answer 32

acquired autoimmune blistering dermatosis with sub epithelial bullae

Question 33

percentage of epidermolysis bulls acquisita presenting with oral lesions

Answer 33

50%

Question 34

what might early and late stage epidermolysis bullosa acquisita mimic

Answer 34

early - pemphigoid late - epidermolysis bulls

Question 35

what is epiedermolysis bullosa

Answer 35

group of rare genetic conditions formation of skin bullae which heal with scarring

Question 36

3 variants of epidermolysis bullosa

Answer 36

simplex junctional dystophic

Question 37

what are oral blood blisters also known as

Answer 37

angina bullosa haemorrhagica

Question 38

what happens with oral blood blisters

Answer 38

spontaneous blood filled bullae, burst to form ulcers and heal uneventfully