2nd Week Discussion Flashcards by Shereen Huff

clinical features of erythema multiforme (3)

Clinical features EM minor: –Skin (extremities) –Mucosa (oral, conjunctival, genitourinary, respiratory) –Hemorrhagic crusting of vermilion zones

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Erythema multiforme

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describe the erythema multiforme lesions on skin (2)

Variety of appearances “multiforme”
• Round, dusky-red patches on skin of
extremities “target lesions

” • Bullae with necrotic centers

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Erythema multiforme (EM)

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• Erythematous patches oral mucosa
that undergo necrosis and result in
large, shallow erosions and ulcers with
irregular borders

Erythema multiforme

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erythema multiforme

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clinical features of erythema multiforme major

–2 or more mucosal sites in conjunction
with skin lesions
• Mucosal, lip and skin lesions as seen
in EM minor

–Ocular involvement can produce
symblepheron

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Erythema multiforme (EM)
• Treatment (supportive therapy):

–Systemic or topical steroids early on

–IV re-hydration

–Topical anesthetic or analgesic for pain

(controversial)

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“Punched-out” interdental papillae

Necrotizing Ulcerative Gingivitis

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Severe pain, oral malodor, spontaneous
hemorrhage

Necrotizing Ulcerative Gingivitis

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describe Necrotizing Ulcerative Gingivitis (3)

“Punched-out” interdental papillae
 Localized or diffuse gingival involvement
 Severe pain, oral malodor, spontaneous
hemorrhage

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Necrotizing Ulcerative Gingivitis

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Necrotizing Ulcerative Gingivitis

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Necrotizing Ulcerative Gingivitis

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NUG - Treatment (4)

Debridement (using topical or local anesthesia)
 Mild salt water rinse or chlorhexidine
 Improve oral hygiene and diet
 Broad spectrum antibiotic may be helpful,
particularly if systemic symptoms

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aka – Herpetic Gingivostomatitis

Primary Herpes

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describe symptoms of primary herpes

Acute fever, cervical lymphadenopathy, oral sores

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Small ulcers often coalesce, resulting in larger
ulcers having serpentine borders

Primary Herpes

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primary herpes

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primary herpes

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ID + tx

first 2-3 days–> acyclovir or valacyclovir (valtrex)

Symptomatic care – analgesics, antipyretics
 Topical anesthetics so patient can eat and
drink – important to avoid dehydration
 Popsicles can be soothing for pediatric
patients

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how long does primary herpes last?

10 to 14 days

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primary herpes has an approximately _____chance of developing at
least one episode of recurrent disease

Approximately 25% chance of developing at
least one episode of recurrent disease

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Recurrent Herpes Two forms:

Recurrent Herpes Labialis
 Recurrent Intraoral Herpes

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aka – cold sore, fever blister

Recurrent Herpes Labialis

Recurrent Herpes Labialis affects where?

Affect vermilion zone or perioral skin

symptoms of Recurrent Herpes Labialis (5)

Prodromal itching, tingling, burning, erythema  followed by cluster of vesicles

what happens with Recurrent Herpes Labialis with no treatmet

With no treatment, vesicles rupture, form a crust, and lesions heal in 7-10 days

Recurrent Herpes Labialis

Recurrent Herpes Labialis is triggered by what

Triggered by UV light exposure or trauma

Recurrent Herpes Labialis -Treatment (4)

Avoid excess sun exposure  Sunblocks may be helpful to prevent lesion development  Topical antiviral agents - statistically significant decrease in healing time  Patient-initiated systemic valacyclovir seems to have best results \*Treatment must be started within first 2-3 days of onset\*

recurrent intraoral herpes occurs where?

Confined to mucosa bound to periosteum (hard palate and attached gingiva)

describe Recurrent Intraoral Herpes

Cluster of shallow ulcers

tx for recurrent intraoral herpes

Heal in one week with no treatment

Recurrent Intraoral Herpes

Chronic immune-mediated disorder

Lichen planus (LP)

name two types of lichen planus

Cutaneous – may resolve in 7 – 10 yr s • Mucosal – typically managed as chronic condition

Cutaneous lichen planus • Clinical features:

Purple polygonal pruritic papules with Wickham’s striae (lacy white lines)

– Cutaneous lichen planus • Clinical features-location

Flexor surface of wrists, lumbar region, shins, but other locations

Cutaneous lichen planus

Oral lichen planus (OLP) • 2 forms:

–Reticular (lacy white lines) –Erosive (ELP)- erythematous, may ulcerate

most common form of oral lichen planu

Reticular form

most symptomatic form of oral lichen planus

Erosive form is most symptomatic, especially with acidic, salty or spicy foods

desribe reticular lichen planus

interlacing white lines

describe erosive lichen planus

shallow ulcers, peripheral erythema and radiating white lines

location of oral lichen planus

Bilateral buccal mucosa, tongue, gingiva common but any intraoral surface and lips

lichen planus

Oral lichen planus (OLP/ELP) • Treatment: for reticular lichen planus

usually no Tx needed • Patient may feel “rough” areas of hyperkeratosis, but no pain

treatment for erosive lichen planus

ELP treat with potent topical steroid • “off label” • Systemic steroids not needed

In PV autoantibodies destroy _____ so waht happens

desmosomes Desmosomes bond epithelial cells together; antibodies inhibit adherence, so a split develops in the epithelium

describe pemphigus vulgaris

• Superficial, ragged erosions and ulcerations

pemphigus vulgaris occurs where

Any mucosal surface

Oral lesions “first to show, last to go”

Pemphigus vulgaris (PV) • In other words – the oral lesions often are the initial manifestation of the disease and the most difficult to resolve with treatment

+ Nikolsky sign

Pemphigus vulgaris (PV)

``` Pemphigus vulgaris (PV) • Treatment: ```

–Systemic corticosteroids, often with azathioprine or other steroid-sparing agents –Topical corticosteroids have little effect

Also known as cicatricial (scarring) pemphigoid

Mucous membrane pemphigoid (MMP)

Resembles PV due to blister formation

Mucous membrane pemphigoid (MMP)

Mucous membrane pemphigoid (MMP) • linical features (con’t): occurs where

–Any mucosal surface, occasionally affects skin

scarring of mucous membrane pemphigoid occurs where

–Scarring • Skin • Symblepheron (conjunctiva) • Scarring on oral mucosa rare

May see intact intraoral blisters

Mucous membrane pemphigoid (MMP)

Mucous membrane pemphigoid (MMP) • Most significant aspect of this condition is

ocular involvement of symblepheron

Mucous membrane pemphigoid (MMP)

Mucous membrane pemphigoid (MMP) • Treatment:

–Depends on extent of involvement • Oral lesions alone - topical steroids, tetracycline/niacinamide or dapsone may be sufficient • Frequent dental prophylaxis, q 3-4 mos. –Refer patient to ophthalmologist for exam and follow-up • If ocular involvement, systemic immunosuppressive therapy indicated

Pruritus early symptom, followed by the development of multiple, tense bullae, blisters on normal or erythematous skin

Bullous pemphigoid (BP)

``` Bullous pemphigoid (BP) • Treatment: ```

–Management similar to cicatricial pemphigoid, but most BP cases resolve spontaneously in 1-2 years