21 Non-infectious stomatitis Flashcards
What is characteristic of non-infective stomatitis?
Recurrent Apthous Stomatitis (RAS) - “canker sores,” apthous ulcers occur in about 20-50% of population, from trauma or stress, T-cell mediated, HLA antigens have been associated, indicating a possible genetic predisposition. Diagnosis - clinical presentation and exclusion of other diseases. Tx: Topical steroids (Dexamethasone elixir -shouldn’t swallow, Fluocinonide), CHX, Amlexanox.
Minor apthae: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis-recurrent apthous stomatitis)
80% - being to develop in childhood, more in females, prodromal symptoms of burning, itching, less than 1.5cm, painful tan ulcers with erythematous borders, almost exclusively on moveable mucosa, most often occur on buccal and labial mucosa. Heal spontaneously in 7-14 days without scarring.
Major apthae: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis-recurrent apthous stomatitis)
10% - “Sutton’s Disease” onset in adolescence, 1.5-3+cm, deeper than minor apthae, Most commonly affects soft palate, tonsillar fauces or pharyngeal mucosa, Can take 2-6 weeks to heal, may cause scarring, recurrent episodes.
Herpetiform apthae: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis-recurrent apthous stomatitis)
10% - 1-3mm ulcers occuring in clusters, onset in adulthood, females, resemble uclers caused by herpes simplex, no systemic signs or symptoms, heal in 7-10 days.
Pseudo apthae: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis-recurrent apthous stomatitis)
Associated with systemic diseases - GI malabsorption (Crohn’s), Vitamin deficiencies - iron, folate, B1, 2,6,12. Behcet’s Syndrome - chronic recurrent disease resulting from a systemic vasculitis. Oral 99%, ocular 70-85%, genital 75%, and systemic involvement. Oral lesions - similar to apthous ulcers, 6 or more, soft palate/oropharynx, ragged borders and variation in size. Pustules on skin of trunk and limbs with genital and corneal ucleration. 10-25% shows CNS involvement. Tx: Systemic/topical steroids, CHX
Lichen planus: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
Named for it’s appearance to the plant lichen (moss). Uknown cause - but pathogenesis is immune mediated through T-cells, slight association with Hepatitis C. Middle aged adults, Skin - purple, pruritic, polygonal papules. Oral - reticular/erosive/bullous/plaque-like appearance. Most common type is reticular characterized by Wickham’s Striae. Most common cause is desquamative gingivitis (LP, pemphigus vulgaris, pemphigoid, allergy). Saw-toothed rete ridges with destruciton of basal cell histology, systemic drugs, hypersensitivity reactions (cinnamon,amalgam) epithlial dysplasia. Tx: Fluocinonide, Clobetasol (topical steroids).
What are the appearance of Pemphigus and which is most common?
Vulgaris (most common), Vegetans, Erythematous, Foliaceus
Pemphigus: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
Severe progressive autoimmune disease that affects the skin and mucous membranes: oral lesions are usually first to appear. 40s-50s. Desmosomes, Painful superficial erosion and ulcerations, Affects most mucosal surfaces but often affects gingiva producing chronic desquamative gingivitis. Can induce epithelial separation by manipulating tissue or producing lateral pressure (+ Nikolski sign). Dx: Suprabasilar epithelial separation with acantholysis. Direct immunofluorescence show antibodies (IgG and C3) around keratinocytes. Tx: systemic steroids.
What is Benign mucous membran pemphigoid?
A chronic autoimmude disease where patients produce antibodies against the structural proteins in their hemidesmosomes which anchor the basal keratinocytes to the underlying connective tissues. And it is a family of related disorders where antibodies are not directed against a single antigen, but many different antigens that compromise the hemidesmosomes.
Benign mucous membrane pemphigoid: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
50-60 years old, 3x more common in females, more common than pemphigus vulgaris, affects oral, ocular and genital mucosa. Ocular scarring can progress to blindness if untreated. Tissue desquamation produces erosion and ulcers. Most commonly affected site is gingica. Tx: Opthalmologic consultation, topical or systemic steroids.
What can Desquamative Gingivitis be a clinical manefestation of?
Lichen planus, pemphigus vulgaris, mucous membrane pemphigoid, allergic reaction (toothpaste, cinnamon, preservatives).
Erythema multiforme: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
An acute onset, immude mediated blistering mucocutaneous condition. Most often following systemic medications or often post-infectious process, esp post-viral. Self-limiting 2-6 weeks, Affects skin and mucous membranes, rarely only the mouth. 20s-30s, MEN MORE AFFECTED, often follows a bacterial or viral infection or drug exposure. Prodromal - fever, malaise, headache, cough, sour throat, 20% recurrence rate.
What are some of the appearances of Erythema Multiforme?
Skin - multiforme, “bulls-eye” lesion, palms and soles. Mucosa - oral ulcers with red irregular borders, lips, labial mucosa, tongue, FOM, soft palate, crusting and bleeding at vermillion zones of lips. Steven-Johnson Syndrome - more severe, extensive mucosal ulceration, genital mucosal ulceration, triggered by meds, can affect internal organs and life threatening. Toxic Epidermal Necrolysis - most severe form! triggered by drug exposure, females, diffuse sloughing of skin and mucosa.
Geographic tongue: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
“Erythema Migrans, Benign Migratory Glossitis” - inflammatory tongue condition of unknown etiology. 2x more common in females, dorsal and lateral borders of tongue, Depapillated areas that are erythematous or normal colored, with the characteristic yellow-white borders that marginate the lesions. Heal spontaneously. Inreased incidence in psoriatic patients. Reiters Syndrome - rare. Oral lesions look like geographic tongue.
Lupus erythematosus: Characteristics, typical population and presentation, etiology, histologic findings and treatment (non-viral stomatitis)
Autoimmune disease. 8x more common in women, avg age 31, classic “butterfly rash”, Discoid LE - lesions confined to skin. Systemic LE - chronic and progressive - can be life threatening and affect organs - CNS, heart, kidney. Lab tests include ANA and antibodies to pt’s own DNA. Corticosteroids, anti-malarial drugs (hydroxylchloroquine), aspirin, NSAIDS.
