Immune-Mediated Mucocutaneous 3 & 4 Flashcards Preview

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Flashcards in Immune-Mediated Mucocutaneous 3 & 4 Deck (56)
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T/F: Cutaneous Lichen Planus is a CHRONIC disorder


- typically disease course is 1-2 years


what groups are most likely to develop Cutaneous Lichen Planus?

Affects adults (1%), 30-60 years of age

Female predilection


what are the clinical characteristics of cutaneous lichen planus?

A) Purple pruritic polygonal papules

B) **Wickham’s striae**


where are Cutaneous Lichen Planus lesions typically found?

how long does this disease typically last?

Flexor surface of wrists, lumbar region, shins

Typically, 1-2 yr disease course


T/F: Oral Lichen Planus only occurs in association with Cutaneous Lichen Planus


May occur alone or with skin lesions


what groups are most likely to develop Oral Lichen Planus?

Adults, with female predilection (3:2)

(Same as cutaneous)


where in the mouth is Oral Lichen Planus found?

which form of oral lichen planus is more COMMON?

which form is more SYMPTOMATIC?

Bilateral buccal mucosa, tongue, gingiva

Reticular form is most common

Erosive form is most symptomatic


Which condition has a longer disease course: oral, or cutaneous, Lichen Planus

ORAL Lichen planus lasts longer

- Protracted disease course, years-decades


what do the lesions from RETICULAR oral lichen planus look like?

Reticular LP: interlacing white lines

(white color due to hyperkeratosis)


where in the mouth would Reticular Oral Lichen Planus show patchy keratosis and atrophy?

Dorsal tongue


what are the clinical manifestations of EROSIVE Oral Lichen planus?

shallow ulcers, peripheral erythema and radiating white lines


T/F: C. albicans infections may be superimposed on BOTH Reticular and Erosive forms of oral lichen planus



what are the main histopathological finding for Oral Lichen Planus?

1) Hyperkeratosis
2) Alternating atrophy/thickening of spinous layer

3) pointed rete ridges
4) degeneration of the basal cell layer
5) band-like infiltrate of lymphocytes


How is Oral Lichen Planus treated?

(give treatment for BOTH reticular and erosive forms)

A) Management includes treatment of any associated candidiasis

B) Reticular LP: usually requires no therapy

C) Erosive LP: should be treated with one of the stronger topical corticosteroids; systemic steroids usually not needed


what is the prognosis for oral lichen planus?

Is OLP precancerous?

A) Prognosis is good

-Controversy exists regarding the OLP as premalignant condition
-Current best molecular evidence does not support a premalignant potential


Oral lichen planus can be confused with what other broad disease category?

Lichenoid Mucositis


what are some types of Lichenoid Mucositis?

A) Lichenoid drug reaction
B) lichenoid amalgam reaction
C) oral mucosal cinnamon reaction

D) lichenoid foreign body gingivitis
E) oral lesions of GVHD or lupus erythematous

F) some epithelial dysplasias


Which disease is "The most common of the significant immune-mediated systemic diseases"

Systemic Lupus Erythematosus


How many Americans are affected by Systemic Lupus Erythematosus?

What population groups are at highest risk?

Approximately 1.5 million affected in U.S.

Women affected 8 to 10 times more often than men
Average age at diagnosis – 31 years


what are the INITIAL symptoms of Systemic Lupus Erythematosus?

Protean (variable) manifestations initially:

1) Fever, weight loss, arthritis, fatigue, malaise
2) Malar “butterfly” rash
3) Skin lesions flare with sun exposure


what are the effects of Systemic Lupus Erythematosus on the organ systems?

1) Renal involvement (40-50%), renal failure

2) Cardiac involvement is common, particularly pericarditis

3) 50% have vegetations on heart valves (Libman-Sacks endocarditis)


What is often the most significant clinical complication for Systemic Lupus Erythematosus (SLE)?

renal failure


Oral lesions are present in _______% of SLE



what are the characteristics of SLE oral lesions?

- May appear as non-specific or lichenoid ulcerations/keratotic areas

- Affect palate, buccal mucosa, or gingiva


T/F: the treatment for SLE oral lesions is usually topical corticosteroids


- secondary candidiasis infection is common


what are the microscopic characteristics of Systemic Lupus Erythematosus (SLE)?

A) Lichenoid pattern microscopically

B) **Positive lupus band test** – deposition of immunoreactants at BMZ of normal skin

C) Anti-nuclear antibodies present (95%), especially to dsDNA


how is SLE treated?

Treatment includes:
A) decreasing patient’s exposure to UV light
B) Mild disease- NSAID agents or anti-malarial drugs
C) more significant cases- Systemic corticosteroids


what conditions would warrant the use of Systemic corticosteroids to treat SLE?

- arthritis
- pericarditis
- nephritis
- thrombocytopenia


what is the prognosis for SLE?

what about the 5 and 10-year survival rates?

Prognosis is variable

5-year survival is 95%
20-year survival falls to 75%


Do men or women have a worse prognosis for SLE?

Worse for MEN

(more common in women, hits men harder)