Benedict- non infectious mucosal diseases

Question 1

Describe the types of oral lichen planus

Answer 1

• Keratotic: reticular, papular, annular, plaque-like
• Erosive: irregular areas of ulceration covered by fibrin exudates/atrophic (epithelial thinning with erythmateous mucosa
• Bullous: formation of bullae that rupture ulcerated and painful surface
• desquamative gingivitis

Question 2

Describe how lichen planus occurs

Answer 2

• body is challenged
• basal epithelial cells express a different antigen
• detected by apcs-> recruitment of T helper cells
• t cytotoxic cells are stimulated and induce apoptosis

Question 3

What are some important characteristics of lichen planus?

Answer 3

• Bilateral
• Symmetrical
• Asymptomatic unless erosive/ulcerative
  buccal mucosa, tongue, gingiva

Question 4

What is the name for lesions that appear to look like lichen planus?

Answer 4

lichenoid lesions

Question 5

Describe diagnosis of lichen planus

Answer 5

• classical signs
• proximity to restoration
• drug reactions
• histology to rule out candida

Question 6

Describe behaviour of lichen planus

Answer 6

• chronic with periods of exacerbation and remission
• 2-3% malignant transformation especially erosive/ulcerative forms

Question 7

Describe management of lichen planus

Answer 7

• Asymptomatic: no treatment
• Symptomatic: topical corticosteroid
• Consider antifungal as needed
• Regular review

Question 8

Describe mucous membrane pemphigoid

Answer 8

• Autoimmune, vesiculobullous mucocutaneous disease with predilection for mucosal sites (subepithelial)
• cicatricial: tendency to scar
• ocular involvement: dryness, scarring affecting vision
  other bodily mucosal involvement

Question 9

who is more prone to mucous membrane pemphigoid

Answer 9

women, 50-80 yrs old

Question 10

What are symptoms of mucous membrane pemphigoid

Answer 10

• easily traumatised palate, buccal mucosa, gingiva
• bullae: rupture and cause scarring
• positive nikolsky sign
• lesions are chronic, painful, persistent
• desquamative gingivitis

Question 11

What is desquamative gingivitis and when is it seen?

Answer 11

bright red patches or confluent ulcers in the attached gingiva with discomfort
OLP and MMP

Question 12

What is the target (autoimmune of MMP)

Answer 12

hemidesmosomes

Question 13

Describe behaviour of MMP

Answer 13

• chronic (remission and relapse)
• good prognosis but significant morbidity (steroid side effect, ocular scarring)

Question 14

Describe management of MMP

Answer 14

Ophthamology consult
Oral lesions-topical steroid

Question 15

Describe pemphigus

Answer 15

• Autoimmune vesiculobullous mucocutaneous lesion
• intra-epithelial blister formation
• blisters rupture to cause a widespread ulceration
• Can cause painful debilitation fluid loss and electrolyte imbalance

Question 16

Describe the oral clinical presentation of pemphigus

Answer 16

• oral mucosal changes first sign 60%
• Widespread superficial painful erosions and ulcerations distributed haphazardly
• Positive nikolsky sign
• easily traumatised areas

Question 17

Describe the bodily clinical presentation of pemphigus

Answer 17

• Eventually all pts develop cutaneous lesion
• flaccid cutaneous bullae quickly ruptures leaving erythematous denuded area
• infrequently, ophthalmic involvement

Question 18

Describe behaviour of pemphigoid

Answer 18

• chronic: rarely results in complete resolution
• Corticosteroid reduce morbidity and mortality
• Previously 60-70% died due to infection and fluid loss/electrolyte imbalance
• today 5-10% mortality

Question 19

Describe management of pemphigoid

Answer 19

• Initial high dose of systemic corticosteroid to control lesion, then lower dose
• often combined with steroid-sparing agents (azathioprine)
• Monitor circulating autoAB using indirect IF

Question 20

Describe erythema multiforme

Answer 20

• Acute vesticulobullous mucotaneous disease
• immune mediated, due to a hypersensitivity
• Characterised by a wide range of clinical presentations

Question 21

When/who is more likely to have erythema multiforme?

Answer 21

Males 20s-30s (older females for toxic epidermal necrolysis)
- herpes (prev infection
- May have been taking medication

Question 22

Describe oral presentation of erythema multiforme

Answer 22

• begins as erythemateous patches that undergo epithelial necrosis
• Result in diffuse, large, shallow erosions and ulcerations with irregular border
• Appear quickly and is painful
• Hard palate and gingiva are spared (keratinised)
• Haemorragic crusing at vermillion border-diagnostic

Question 23

Describe skin presentation of erythema multiforme

Answer 23

• 1/2 of cases
• bullseye target shaped lesions
• evolve into bullae with necrotic centres
• typically on extremities

Question 24

Describe management of erythema multiforme

Answer 24

• mild forms subside in ~10 days
• likelihood of recurrence
• Mortality: EM major 10%, TEN 30%
• systemic or local corticosteroid
• Rehydration if dehydrated
• prophylactic acyclovir against herpes