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Oral Medicine and Diagnosis > Vesiculobullous and Ulcerative Lesions part 1 > Flashcards

Vesiculobullous and Ulcerative Lesions part 1 Flashcards

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1
Q

oral lichen planus seen _____ frequently than cutaneous lichen planus

A

more

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2
Q

which type of lichen planus is more persistent and more resistant to tx

A

oral lichen planus

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3
Q

what ages get lichen planus

A
  • occurs in 4th-8th decades
  • mean age in 5th decades
  • rare in children
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4
Q

what is the incidence of lichen planus

A

-3-4% incidence; 25% with oral lesions have concomitant skin lesion
- 0.5-1% cutaneous incidence; 50% also have oral lesions
- white females (60%)

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5
Q

what are the frequency of sites of lichen planus

A
  • bilateral and often quasi-symmetric distribution
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6
Q

what is the oral site frequency of lichen planus

A
  • buccal mucosa
  • tongue
  • gingiva
  • lips
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7
Q

what are the skin sites in LP

A
  • forearm
  • shin
  • scalp
  • genitalia
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8
Q

what is the pathophysiology of LP

A
  • autoimmune disease; t-lymphocytes attack langerhan cells in epithelium of affected areas
  • causes chronic inflammatory lesions with varying episodes of intensity
  • not infectious
  • not hypersensitivity
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9
Q

what is the etiology of LP

A
  • NSAIDs - ibuprofen and naproxen
  • various medications for heart disease and HTN, and RA - hydrochlorothiazide
  • hep C and other types of liver disease
  • vaccines - Hep B, various flu vaccines, COVID vaccine uncertain
  • food allergens
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10
Q

what are instigating factors for LP

A
  • co-morbidities such as DM
  • alcohol, tobacco
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11
Q

what is the clinical presentation of LP

A

erythematous
- ulcerated
- keratotic triations
- episodic pain to severe discomfort

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12
Q

what are the clinical symptoms for LP

A
  • asymptomatic
  • itching
  • episodic pain
  • severe discomfort
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13
Q

what are the clinical types of LP

A
  • reticular
  • erosive
  • patch
  • bullous
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14
Q

what is the most common LP

A

reticular

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15
Q

what is the most painful LP

A

erosive

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16
Q

what LP stimulates dysplasia

A

patch

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17
Q

what LP is clinically similar to diseases of greater morbidity

A

bullous

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18
Q

how is reticular LP described clinically

A

lacy
- striated
- wickham striae

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19
Q

where is erosive LP seen

A
  • buccal and labial mucosa
  • tongue laterodorsum
  • gingiva
  • palate
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20
Q

describe the clinical presentation of erosive LP

A
  • large, irregular atrophic erythematous patches diffuse outlines
  • progress to ulcerations, pseudomembranous cover
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21
Q

what are the symptoms of erosive LP

A
  • epsidoic pain to severe discomfort
  • symptoms may persist weeks or longer
  • symptoms result in weight loss, nutritional deficiencies and depression
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22
Q

what is the DDX for LP

A
  • lichenoid dysplasia
  • contact stomatitis
  • lichenoid reaction
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23
Q

what are the treatment goals for lichen planus

A
  • there is no cure
  • reduce length and severity of symptoms
  • resolve oral mucosal lesions
  • reduce risk of malignant degeneration to squamous cell carcinoma
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24
Q

what are the tx issues with LP

A
  • maintain good OH because good OH reduces symptom severity
  • OH is difficult to accomplish during active disease
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25
what are the medications used to treat LP
- oral anesthetic rinse - 1% dyclonine solution - antibiotics - antifungals with steroid- nystatin with triamcinolone - corticosteroids
26
what is the treatment regimen with topicals for LP and why is it used
- 4-6 week course - most popular, best success with steroid carriers
27
what is the mild treatment regimen for LP
- cortisone 5% ointment - triamcinolone 0.1% ointment
28
what is the moderate treatment regimen for LP
- cortisone 10% ointment - fluocinonide gel 0.05% - dexamethasone 0.05% ointment
29
what is the potent treatment regimen for LP
- clobetasol 0.05% ointment/gel - halobetasol 0.05% ointment
30
what is the difference between steroid carriers and bleaching trays
need to border mold the impressions so tray extends to mucobuccal folds with steroid carriers
31
what is the treatment regimen for intra lesion steroid injections for LP
- 12 mg/week dexamethasone for 8 weeks - 5-10 mg/wek triamcinolone PRN
32
what is the treatment regimen for systemic steroids with LP
- prednisone 2-3 weeks - loading dose 0.5-1mg/kg/day (40-80 mg/qd) - need tapering down regimen
33
what is the treatment regimen for methotrexate
- 10-20 mg once weekly for 4-12 weeks
34
what other medications are used to treat LP
- hydroxychloroquine (plaquenil) - thalidomide - calcineurin inhibitors - dapsone
35
what is the issue with thalidomide
- bad history when used in pregnancy for anxiety, morning sickness headache - thalidomide babies had lack of appendage development or other aplasias such as ears or malformed kidneys
36
what is the contemporary use for thalidomide
inflammatory mucocutaneous diseases
37
what is hydroxycholoroquine used for
disease modifying anti RA drug (DMARD), anti malarial, anti COVID - relieve inflammation, swelling, stiffness and joint pain
38
what do calcineurin inhibitors do
- anti inflammatory medication primarily used for anti graft rejection - pimecrolimus cream - tacrolimus ointment - psychotic and renal side effects when used systemically
39
what is dapsone
- an antibiotic with anti inflammatory properties - can block multiple PGEs and leukotrienes thereby blocking their inflammatory effects - potential risk of renal vasculitis
40
what is the risk for untreated LP
- malignant potential risk is 0.1-0.2%
41
which types of LP have the greatest risk of transforming to malignant
erosive and ulcerative conditions
42
what are the 3 types of aphthous stomatitis
- minor - major - herpetiform
43
what is the prevalence of aphthous stomatitis
affects 18-27% of the population - prevalence is about 20%
44
what is the etiology of aphthous stomatitis
unknown - no viral or infectious agent identified - probbaly is focal immunodysfunction but mechanism is undetermined - HLA subtype susceptibility is a factor
45
what are the triggers for apthous stomatitis
stress/anxiety, hormonal changes, dietary factors, trauma
46
what are human leukocyte antigens and what do they do
a system or complex of genes on chromosome 6 in humans which encode cell surface proteins responsible for regulation of the immune system
47
HLA subtype allele mutations permit:
dysregulation of the immune system taht affects mucosa and cutaneous tissues and cause outbreaks of aphthous stomatitis
48
in aphthous stomatitis alterations in mucosal membrane barrier permeability may be a factor because of co morbidity associations with:
- HIV/AIDS - bone marrow suppression - neutropenia - gluten sensitivty - Chron's disease - ulcerative colitis - food allergy - behcet disease - dietary deficiencies such as iron, zinc and vitamin B12
49
what is the clinical description of aphthous stomatitis ulcers
- 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
50
describe aphthous minor and when does healing occur
- most common subtype - single but more often multiple - less than 1cm in diameter - oval to round shape - healing within 7-14 days
51
describe ahphtous stomatitis major and what is its other name
- sutton disease - 1cm or greater - single or less commonly several - deep - to ragged edges with elevated edematous margin - may persist for several weeks to months - often heal with scarring
52
describe herpetiform aphthous stomatitis
- least common variant - grouped superficial ulcers 1-2mm diameter - crops of 10-100 lesions - lesions coalesce - in nonkeratinizaed and keratinized tissues - healing within 7-14 days - no etiologic role for herpes simplex virus
53
what is the dx for aphthous stomatitis
- usually has diagnostic clinical appearance of focal, well- defined ulcers involving non keratinized mucosa - history helpful; a recurrent process - positive family history
54
what is the DDX for aphthous stomatitis
- traumatic ulcer - chancre - recurrent intraoral herpes simplex virus HSV-1 - cyclic neutropenia
55
what is the treatment for aphthous stomatitis
- symptomatic therapy - systemic causative factors should be addressed - tetracycline based oral rinses may be helpful - corticosteroid therapy- most rational and most consistently effective - topical corticosteroids as gels, creams or ointment 4-6 times/ day to early lesions - intralesional corticosteroid injections - short duration systemic corticosteroids ( low to moderate doses) - other immunomodulating drugs may be helpful - colchicine sometimes beneficial - thalidomide treatment
56
what immunomodulating drugs are helpful in aphthous stomatitis lesions
- dapsone - hydroxychloroquine - topical tacrolimus - amelexanox
57
what dosage of colchicine for aphthous stomatitis
0.6-1.2mg/day
58
which form of aphthous stomatitis is more common recurrent form
minor
59
how often do minor aphthous stomatitis lesions appear
episodic, 1-4 episodes/year - few lesions, usually minor or herpetiform
60
how often do major aphthous sotmatitis lesions appear
almost continuous ulcerations; disabling large or severe lesions
61
what is the difference in AIDS patients with aphthous stomatitis
lesions are more severe and may occur on any oral surface
62

Oral Medicine and Diagnosis (12 decks)

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