Ulcerated lesions Flashcards
what is an ulcer
localised surface defect with loss of epithelium exposing underlying inflamed tissue
causes of ulcers
infective
traumatic
drugs
idiopathic
associated with systemic or dermatological disease
neoplastic
viruses that can cause ulceration
Herpes simplex virus
varicella zoster virus
cytomegalovirus
coxsackie
drugs that can cause ulceration
nicorandil
NSAIDs
idiopathic cause of ulceration
recurrent aphthous stomatitis
ulceration associated with systemic disease
haematological disease
GI disease
HIV
ulceration associated with dermatological disease
lichen planus
discoid lupus erythematosus
ummunobullous diseases
neoplastic ulceration
oral squamous cell carcinoma
what is a vesicle
small blister
what is a bulla
blister over 10mm
when does a vesiculobullous lesion usually present as oral ulceration
following rupture of vesicles/bullae
what is a subset of lesions known as
immunobullous disorders
how are disorders which result in vesicles/bullae classified
depending on the location of the bulla
what are immunobullous disorders
autoimmune diseases in which autoantibodies against components of skin and mucosa produce blisters
classification of disorders which result in vesicles/bullae
intraepithelial
sub epithelial
subgroup of intraepithelial disorders which result in vesicles/bullae
non-acaztholytic (death and rupture of cells) e.g. viral infection
acantholytic (desmosomal breakdown)
example of intraepithelial - non acantholytic virus
Herpes simplex virus
example of intraepithelial - acantholytic lesion
pemphigus
what is pemphigus
group of autoimmune diseases that affect the skin and mucous membranes
pemphigus vulgarise what happens to bullae
bullae form in skin and mucous membranes then rupture to leave ulcers
treatment of pemphigus vulgarisms
steroids
Histopathology of pemphigus vulgaris
characteristic intraepithelial bullae produced by acantholysis
what is used to confirm diagnosis of pemphigus vulgaris
direct immunofluorescence (DIF) in conjunction with routine histopathology
what is mandatory for direct immunofluorescence
fresh specimen
sub epithelial examples
pemphigoid
erythema multiform
dermatitis herpetiformis
epidermolysis bulls acquisita
groups of pemphigoid
bullous
mucous membrane
linear IgA disease
drug induced
where is usually the first affected site in mucous membrane pemphigoid
oral mucosa
how do gingival lesions present as in mucous membrane pemphigoid
desquamative gingivitis
how do bullae present in mucous membrane pemphigoid
tend to be relatively tough as the ‘lid’ is full thickness epithelium
treatment of mucous membrane pemphigoid
steroids
histopathology of mucous membrane pemphigoid
separation of full thickness epithelium from connective tissue producing subepithelial bulla with a thick roof
what do you use to confirm diagnosis of mucous membrane pemphigoid
direct immunofluorescence (DIF) in conjunction with routine histopathology
what is epidermolysis bulls acquisita
acquired autoimmune blistering dermatosis with sub epithelial bullae
percentage of epidermolysis bulls acquisita presenting with oral lesions
50%
what might early and late stage epidermolysis bullosa acquisita mimic
early - pemphigoid
late - epidermolysis bulls
what is epiedermolysis bullosa
group of rare genetic conditions
formation of skin bullae which heal with scarring
3 variants of epidermolysis bullosa
simplex
junctional
dystophic
what are oral blood blisters also known as
angina bullosa haemorrhagica
what happens with oral blood blisters
spontaneous blood filled bullae, burst to form ulcers and heal uneventfully
