Oral Pathology Ch.3-2

very tiny (1 – 2 mm)
resemble ulcers caused by the herpes simplex virus
painful and develop anywhere in oral cavity usually grouped
* ulcers from herpes simplex appears on mucosa fixed to bone – palate and gingival
“Bound down mucosa”
hard to distinguish from 1° herpesway to distinguish is that with

Ways to distinguish is that with 1° herpes:

“hives” appears as multiple areas of well-demarcated swellings associated with itching (pruritus)

caused by localized areas of vascular permeability in superficial CT beneath epithelium

diffuse swelling of tissues caused by permeability of deeper blood vessels but no itching
- usually the lips are affected

both are similar lesions
Tx includes use of Antihisamines (Benadryl-diphenhydramine)

lesions resulting from the direct contact of an allergen with the skin or mucosa
-Type IV hypersensitivity
-most common cause – latex; but can be caused by other things to: local anesthetics, acrylic, metals
Tx – topical/systemic corticosteroids

mucosa comes erythematous/edematous accompanied by burning/itching

erythematous, swelled and becomes encrusted with scaly, white epidermis

lesions that appear in the same site each time a drug is introduced
subside when drug is removed
single or multiple slightly raised reddish patches or clusters of macules on skin
pain & itching
Type III hypersensitivity
Tx – discontinue use of drug after it’s been identified

most severe form of erythema multiforme?

mucosal lesions more extensive and painful; genital mucosa/mucosa of eyes; lips generally encrusted/bloody
eye lesions can lead to blindness

some possible causes: herpes simplex, TB, histoplasmosis, drugs – barbiturates and sulfonamides
Tx – topical corticosteroids; systemic steroids

-acute, self-limited disease affecting the skin and mucous membrane
-occurs in young adults and affects men more commonly than women
-characteristic skin lesion – “Bull’s eye or target” – concentric rings of with normal skin color
- can affect oral cavity with or without the skin – oral – ulcers
-ulcers on lateral borders of tongue; crusted and bleeding lips
-explosive onset

Straie?

if the epithelium separates from the CT and erosions, bullae, or ulcers form its called?

-benign, chronic disease affecting the skin and oral mucosa
-characteristic pattern of interconnecting lines (striae) resembling the pattern of the plant as it grows on rocks and trees (lace appearance)
-common in middle age with slight female predominance

this can be caused by lichen planus?

-skin lesions of lichen planus – 2 – 4 mm papules located: lumbar region, flexor surfaces of wrist, anterior surface of ankles
-dx made upon clinical appearance and histologic appearance of biopsy
-chronic disease that is treated symptomatically
-Tx with topical corticosteroids
-Suggested that patients with lichen planus are more at risk to develop Squamous Cell Carcinoma

-unknown cause
-antigenic marker HLA-B27 present suggestive of genetic influence
-more prevalent in men than women
-develops 1 – 4 weeks after venereal or GI infection

-radrographically – periosteal proliferation on heels, ankles, metatarsals, phalanges, knee, and elbows
-aphthous-like ulcers, erythematous lesions, and geographic tongue-like lesions in oral cavity
-lasts from weeks – months
-Tx with ASA (aspirin) or NSAIDS (non-steroidial anti-inflammatory drugs)

Also called Langerhans cell granulomatosis

3 entities grouped under Histocytosis X:

-acute fulminating disorder affecting children younger than 3 years
-resembles a lymphoma – rapid and fatal
-some times responds to chemotherapy

-children less than 5 years
-classic triad in 25% of patients:
-single-multiple “punched-out” (RL) in skull
-unilateral or bilateral exophthalmos
-diabetes insipidus
-oral manifestations

sore mouth, halitosis, gingivitis, loose teeth, non-healing extraction sites, appearance of advanced periodisease

-older children/adults, males
-skull/mandible involved
-lesion resembles periodontal disease or PA inflammation or as a well-circumscribed (RL) with or without sclerotic borders
-Tx – conservative surgical excision and radiation

These diseases causes tissue damage because the immune system treats the person’s own cell’s and tissues as antigens

-affects salivary and lacrimal glands
-casue unknown
-50% have other autoimmune diseases – rheumatoid arthritis/systemic lupus
-major/minor salivary glands involved – 50% have Parotid enlargement
-also susceptible to lymphoma

eye involvment can create this?
abnormal visual intolerance to light

20% of patients also have this?
disorder afffecting the fingers and toes

90% have a positive reaction to this?
an antibody to IgG

lab abnormalities include:
-mild anemia
-dec WBC count
-elevated erythrocyte sedimentation rate
-diffuse elevation of serum immunoglobulins
*dx made when 2 of the 3 components are present: xerostomia, rheumatoid arthritis, or keratoconjunctivitis sicca

-acute/chronic inflammatory autoimmune disease of unknown cause
-syndrome that includes a wide spectrum of disease activity and signs and symptoms ranging from skin lesions to wide spread, debilitating, life threatening disease with multiple organ involvement
-both cellular and humoral immunity are impaired
-85% of individuals have skin lesions
-classic “Butterfly” rash occurs across the bridge of the nose, and some lesions on the fingertips

-arthritis/myositis can occur
-psychoses/depression are signs of CNS involvement – seizures can be present
-pericarditis, cardiac arrhythmias, & endocarditis may be seen late in the disease
-kidney involvement
-dx based on classic multiorgan involvement and presence of antinuclear antibodies in serum

Tx’s: -ASA/NSAIDS for mild symptoms
-Hydroxychloroquine (anitmalarial)
-Corticosteroids with azathioprine & cyclophosphamide
- Excellent prognosis with mild symptoms, but can be fatal
-Kidney failure is cause of death in SLE -SBE prophylaxis recommended (sub-acute bacterioendocarditis)

Pemphigus Vulgaris is characterized by intraepithelial blister formation that results from breakdown of the cellular adhesion between epithelial cells?

-severe, progressive autoimmune disease affecting the skin and mucous membranes
-most frequently seen type of pemphigus
-oral lesions appear as shallow ulcers to fragile vesicles or bullae

Pemphigus Vulgaris is characterized by this? Sloughing with finger pressure

What are the 3 types of pemphigus:

-“benign mucous membrane pemphigoid” – BMMP
-chronic autoimmune disease affecting oral mucosa, conjunctiva, genital mucosa, and skin (requires referral to multiple specialists)
-lesions occur as a result of cleavage of epithelium from underlying CT (acantholysis)
-heals with scaring

-“benign mucous membrane pemphigoid” – BMMP
-chronic autoimmune disease affecting oral mucosa, conjunctiva, genital mucosa, and skin (requires referral to multiple specialists)
-lesions occur as a result of cleavage of epithelium from underlying CT (acantholysis)

most common site is gingiva -appearance from erythema to ulceration and involves both free/attached gingival
-gingival lesions termed – desquamative gingivitis

Dx made by biopsy/histologic examination
-Direct immunofluorescence shows a linear pattern at basement membrane
-Tx: topical/systemic corticosteroids
-Eye damage is possible – can lead to blindness

-very similar to BMMP with incidence occurring in older patients > 60 years
-Tx – NSAIDS – corticosteroids

-chronic recurrent autoimmune disease consisting 1° of oral ulcers, genital ulcers, and ocular inflammation
-around 30 years old
-oral ulcers very similar to aphthous ulcers
-genital ulcers are small and located on scrotum or base of penis labia majora
-skin lesions are papular and pustulate and occur on the trunk and limbs

-Dx: 2 of 3 need to be present [oral, genital, ocular]
-Pustule developing after needle puncture is highly suggestive
-Tx: systemic/topical corticosteroids