ulcerations pt.2 Flashcards
in severe cases of contact allergic stomatitis (plasma cell stomatitis) what is the treatment ?
application of topical corticosteroid
when do oral ulcerations due to drugs or radiation in cancer treatment appear?
drugs :5-10 days after starting
radiation : 2nd week
treatment of AUG (prescription )
hydrogen peroxide 1.5-2% in water x3 a day
12%chlorohexidine
metronidazole and penicillin
drugs associated with pemphigus ?
penicillamine and captopril
cause of pemphigus vulgaris ?
auti antibodies igG react with desmosomal hlycoprotiens forming intra-epithelial bullae.
oral lesions are first to show , last to go
clinical features of pemphigus vulgaris :
mucosal and skin surface may be involved. conjunctival, pharyngeal, and laryngeal mucosa may all be involved
-oral lesions in 60% of patients
-desquamative gingivitis
-irregular shallow oral ulcers
+nikolsky sign
what will a biopsy of pemphigus vulgaris lesion show?
tombstone apperance with tzanck cells , supra-basillar acantholysis
treatment for pemphigus vulgaris ?
high dose systemic steroids 1-2mg/kg/d + cytotoxic agents (azathioprine or cyclophosphamide)
what is para-neoplastic pemphigus ?
severe variant of pemphigus associated with underlying neoplasm (non-hodgkins lymphoma, chronic lymphocytic leukemia , or thymoma)
lesions resemble inflammatory lesions of a drug reaction, lichen planu or EM
oral disease is extensive and painful
whats the benign variant of pemphigus called? what are its types?
pemphigus vegetans
A.) neumann type : large bullae on healing from vegetations of hyperplastic granulation tissue
B.) hallopeau type: less aggressive , pustules followed by verrucous hyperkeratotic vegetations
mucous membrane pemphigoid manifestations ?
desquamative gingivitis , involvment of conjunctiva , nasal, oesophageal, larngeal mucosa . ulcers result in scars
-self limiting
-ulcers may presist for weeks-months
+nikolsky sign
-blindness is very common
what is linear IGA disease?
similar to MMP but instead of IgG Its IgA
what is chronic bullous disease of childhood?
deposition of igA antibodies in basement membrane zone in children below 5
-disease is preidcted by URTI or drug therapy
-genital involvement
-oral mucosa involevment in 50% of cases
-self limiting disease with lesions healing within 2 years
what causes histoplasmosis ?
histoplasma capsulatum from inhaling contaminated dust
oral findings of histoplasmosis :
-oral lesions may appear as papule, nodule , ulcer or vegetation
-untreated single lesions progress to a firm papule to nodule which ulcerates and slowly enlarges
-cervical lymph nodes are enlarged and firm
-lesions resemble that of squamous cell carcinoma
how do you diagnose histoplasmosis ?
culture of infected tissue or exudates on sabourauds dextrose agar
what is the treatment for histoplasmosis ?-blastomycosis too
mild-moderate: ketoconazole or itraconazole for 6-12 months
immuno-supressed patients or patients with severe disease require IV amphotericin B for 10 weeks (3 months for mucromycosis)
most common oral presentation of blastomycosis ?
non-specific painless verrucous ulcer with indurated borders, often mistaken fo SSC
-nodules and radiolucent jaw lesions
how is diagnosis of blastomycosis done ?
on basis of biopsy .
histologic apperance shows pseudoepitheliomatous hyperplasia with a heavy infiltrate of chronic
inflammatory cells and microabscesses.
what is mucormycosis ?
infection with saprophytic fungus that normally occurs in soil or as a mold on decaying food
fungus is non pathogenic for healthy individuals
oral findings of mucormycosis ?
ulceration of the palate from necrosis due to invasion of palatal vessel. lesion is characteristically large and deep causing denudation of underlying bone, gingiva, lip, and alveolar ridge
histopathologic sample of mucormycosis shows:
necrosis and nonseptate hayphe which are best demonstrated by periodic acid aschiff stain
what is histochemistry staining ?
staining used to localize specific chemical constituents of tissues and cells
monitored by formation of an insoluable precipitate that takes a certain color
based on :
-enzyme activity: NOS
chemical reactivity:PAS
IN IMMUNOHISTOCHEMISTRY , THE ANTIBODY IS TAGGED WITH MARKER
