Vesiculobullous and Ulcerative Diseases

Question 1

T/F: Oral lichen planus (OLP) more frequently than
the cutaneous LP

Answer 1

True

Question 2

• Occurs in fourth to eighth decades
• mean age in 5th decade
• Rare in children
Bilateral and often quasi-symmetric
distribution
• Oral site frequency: 1. buccal mucosa
2. tongue
3. gingiva
4. lips
• Skin sites: forearm, shin, scalp, genitalia
not infectious
not hypersensitivity
autoimmune disease; T-lymphocytes
attack Langerhan cells in epithelium of
affected areas
Causes chronic inflammatory lesions
with varying episodes of intensity

Answer 2

Oral LIchen planus

Question 3

Etiology
● NSAID’s (ibuprofen and naproxen)
● Various medications for heart disease,
hypertension (hydrochorthiazide, etc.) ,
rheumatoid arthritis
• Hepatitis C infection and other types of
liver disease
• Vaccines - Hepatitis B, various flu vaccines,
effect of the COVID vaccine uncertain
• Food allergens, dental materials or other
substances
Co-morbidities are contributary
- Diabetes
Vices are contributary
- EtOH, tobacco, etc.
● Erythematous
● Ulcerated
● Keratotic striations
● episodic pain to severe discomfort.

Answer 3

Oral Lichen planus

Question 4

● lacy
● striated
● “Wickham” striae

Answer 4

Reticular lichen planus

Question 5

Large, irregular atrophic erythematous patches
diffuse outlines
Progress to ulcerations, pseudomembranous cover
Episodic pain to severe discomfort
Symptoms may persist weeks or longer
Symptoms result in weight loss, nutritional
deficiencies and depression.

Answer 5

Erosive lichen planus

Question 6

• no viral or other infectious agent identified
• probably represents focal immunodysfunction but the specific mechanism is undetermined.
• Triggers include increased stress/anxiety, hormonal changes, dietary factors, trauma, etc…)
• Human leukocyte antigen (HLA) subtype susceptibility a factor in some cases (-B12, -B51, and others)
• Alterations in mucosal membrane barrier permeability may be a factor because of co-morbidity associations with:
HIV/AIDS
bone marrow suppression
Neutropenia
gluten sensitivity
Crohn’s disease
ulcerative colitis
food allergy
Behçet disease
dietary deficiencies
iron
Zn
vitamin B12 (folate)
Recurrent, self-limiting,
painful ulcers
• Usually restricted to
nonkeratinized oral and
pharyngeal mucosa (not
hard palate or attached
gingiva)
• Well-demarcated ulcers
with yellow fibrinous base
and erythematous halo

Answer 6

Aphthous stomatitis

Question 7

• Autoimmune; trigger
unknown
• Autoantibodies directed
against basement
membrane zone antigens
causes ulceration
Clinical Presentation
• Vesicles and bullae followed by
ulceration
• Multiple intraoral sites
(occasionally gingiva only)
• Usually in older adults
• 2:1 female predilection
• Ocular lesions noted in one-third
of cases
• scarring tendency in ocular,
laryngeal, nasopharyngeal, and
oropharyngeal tissues (Cicatricial
Pemphigoid)

Answer 7

Mucous Membrane Pemphigoid

Question 8

• An autoimmune disease where
antibodies are directed toward the
desmosome-related proteins of the
epithelial intercellular bridges
(desmoglein 3 or desmoglein 1)
• A drug-induced form exists with less
specificity in terms of immunologic
features, clinical presentation, and
histopathology
• Painful, shallow irregular
ulcers with friable adjacent
mucosa
• Nonkeratinized sites (buccal,
floor, ventral tongue) often are
initial sites affected
• + Nikolsky sign

Answer 8

Pemphigus vulgaris