Please enable JavaScript.
Coggle requires JavaScript to display documents.
Dermatological Lesions (Lichen Plannus (Chronic mucocutaneous lesion of…
Dermatological Lesions
Lichen Plannus
-
- OLP - Oral Lichen Proper
- OLR - Oral Lichenoid Reaction
Histology
- Liquefactive degeneration of basal cells
- apoptosis = pinkish globules
- Civatte bodies
- Dense, band-like inflammatory infiltrate of lymphocytes
- Normal maturation towards the surface
- Hyperkeratosis
Diagnosis
= histopath or Immunofluorescence
- Characteristic deposition of fibrinogen outlining the BMZ and extending irregularly into the lamina propria “shaggy”
- Presence of IgG, IgA, IgM and C3 positive civatte bodies (apoptotic bodies)
= Drug Hx
- OLR more unilateral, more ulcertaive, more diffuse lymphocytic infiltrate, Civatte bodies
Behavior
- Usually persist for many years with relapses (exacerbation) and remissions (quiescent)
- PMODs
- 2-3% malignant transformation, especially in erosive/ ulcerative form
- OLR associated malignant transformation
Clinically
- Cutaneous
- Pink papules on the flexor surface of extremities
(Wickham’s striae)
- Oral
- Most (90%): Bilateral, Buccal mucosa, asymptomatic unless erosive/ ulcerative
- Keratotic: Reticular, Papular, Annular, Plaque-like
- Erosive: irregular areas of ulceration covered by fibrin exudates and atrophic
- Bullous: Formation of bullae that rupture ulcerated and painful surface
- Desquamative gingivitis
-
-
Pemphigoid
Bullous Pemphigoid Skin/Oral autoimmune, blistering disease in the old population
Diagnosis
- C.f. MMP, circulating auto-AB can be detected in the serum
- C.f. Pemphigus, the circulating auto-AB level does not correlate with disease activity
Clinical
- Mostly skin- bullae with erythematous skin that ruptures and heals without scarring
Mucous Membrane Pemphigoid (MMP) Oral Autoimmune, vesiculobullous mucocutaneous disease
Diagnosis
- Auto-Ab (C3,IgG) deposition along the basement membrane zone on DIF
- Antigenic targets: Transmembrane glycoproteins in hemidesmosome
Clinical
- Oral = Easily traumatised areas, palate buccal mucosa, gingiva
- Bullae formation is Sub-epithelial, which ruptures and ulcerates and scars (sloughing of lesion)
- Desquamative gingivitis
Histology
- Subepithelial clefting and no acantholysis
- Mild mixed chronic inflammatory cell infiltrate in the connective tissue
Lupus Erythematosus
Systemic Lupus Erythematosus (SLE)
An autoimmune connective tissue disease, with cutaneous and oral manifestations
Systems Affected:
- Face = Butterfly rash (50%)
- Kidney = leads to kidney failure
- Cardiac = pericarditis and endocarditis
- Oral = ulcerations, erythema and hyperkeratosis (may resemble OLP), palate and buccal mucosa
Histology
- Hyperkeratosis
- atrophy and acanthosis of the spinous cell layer
- Basal cell degeneration
- perivascular inflammation
Diagnosis
- DIF
- Deposition of one or more of (IgM, IgG, C3) in a shaggy, granular band at BMZ
- IF
- ANA (antinuclear antibodies): SLE: 95%, CCLE usually negative
Management
- Avoid excessive sun exposure
- Mild: NSAIDS
- Severe: systemic corticosteroids
Chronic Cutaneous Lupus Erythematosus (Discoid)
Primarily affects the skin and oral mucosa, called DLE
- Skin lesions = Begin as a scaly erythematous patch on sun-exposed skin and are exacerbated by sunlight
- Oral = clinically identical to erosive OLP, usually w/ skin lesions
Subacute Cutaneous Lupus Erythematosus
- Clinical features in between SLE and CCLE
Erythema Migrans
Geographic tongue, migratory glossitis
Histology
- Hyperparakeratosis, spongiosis, acanthosis
- Elongated rete ridges
- Mixed inflammatory cells in the lamina propria
Clinical
- Multiple, well-demarcated zones of erythema (atrophy of the filiform papillae)
- elevated, yellow/white serpentine/scalloped boarder
- anterior 2/3s of tongue
- asymptomatic, may have burning /sensitivity to spicy food