Neurofibromatosis - ANSWER: = multiple neurofibromas can occur anywhere
- small papules, large nodules, pedunculated masses
- *CROW'S SIGN* (Axillary Freckling)
- Lische nodules, brown pigmented spots on iris
- Cafe Au Lait Pigmentation
- *ORAL LESIONS 72-92% OF CASES*
Peutz-Jeghers Sydrome - ANSWER: = autosomal dominant, freckle-like lesions in and
around oral cavity
- intestinal polyposis with predisposition to change into ADENOCARCINOMA
- intestinal polyps in JEJUNUM and ILEUM of SMALL INTESTINE, with 2-3%
malignancy transformation, can cause blockage
Ehlers-Danlos Syndrome - ANSWER: = multiple variations of abnormal collagen
production due to genetic abnormalities
- hypermobility of joints and elasticity of the skin
- don't heal well, can have huge scars
- 50% can tough their nose with their tongue
- *Subluxation of the TMJ*, *Bruising and Bleeding of the Oral Tissues*
Lichen Planus - ANSWER: = *MOST COMMON DISEASE SEEN IN ORAL MEDICINE*
- chronic inflammatory disease that causes white triations, papules, or plaques on
the buccal mucosa, tongue, and gingiva
- 45-60, Women 2x men, rare in children
- skin lesions common; IS AN ORAL DISEASE THAT MAY HAVE SKIN LESIONS, also nails
and conjunctiva
- T-cell mediated autoimmune disease in which CD8 cells trigger apoptosis of oral
epithelial cells
- alcohol and tobacco greatly increase risk
- people with persistent mouth sores are at increased risk to get SCC
Tx: don't treat if not painful; want to keep it from breaking down
- *Steroids* for oral lesions, lidocaine for pain, *Magic Mouthwash*
- Goal is to keep it RETICULAR, do not want it to break down
Where are the most common locations for Lichen Planus? - ANSWER: Buccal >
Tongue > Gingiva > Lips
Lichen Planus - Histology - ANSWER: - Basal cell layer looks like it's not there, forms a
little *pink band*
- Under pink band is a band of lymphocytes
,- SAW-TOOTHED RETE RIDGES
- Bottom left picture is ERROSIVE LICHEN PLANUS
What is a common cause of Lichen Planus? - ANSWER: = Lichenoid Drug Reactions
- He usually blames HYPERTENSIVES and DIURETICS
- *20% are medication-induced*, others are allergic or immunologic
- also CHRONIC HEPATITIS C
- psycogenic (stress and anxiety)
- dental materials
- is NON-STEROIDAL, use if Clobetasol is not effective enough
BLACK BOX: might cause cancer
How many cases of Lichen Planus are medication-induced? - ANSWER: = 20% (1/5)
- HYPERTENSIVE, GOUT medications
- *ATENOLOL*********, is a HTN medication/beta-blocker
Lichen Planus Skin Lesions - ANSWER: = the 4 P's
1. Purple
2. Polygonal
3. Papular
4. Pruiritic
Chronic Ulcerative Stomatitis (CUS) - ANSWER: = painful, exacerbating and remitting
oral erosions, and ulcerations
, - possibly a severe variant of Lichen Planus
Tx: usually resistant to steroids
- *Hydroxychloroquine (Plaquenil)* is often used (Systemic Steroid)
- 200 mg Plaquenil 2x/day
What does a patient require if they are on Plaquenil? - ANSWER: = 1x per year eye
exams (can get eye lesions)
- Liver enzyme panel 2x per year, screening for AST/ALT ratio
Nikolsky Sign - ANSWER: = first used in 1895 to DIAGNOSE PEMPHIGUS
- *Dislodgement of skin by lateral pressure*
- indicates multiple diseases
BMMP - Eye Lesions - ANSWER: = ocular invovlement MOST SIGNIFICANT with
Pemphigoid
- may lead to blindness
- 25% in one eye before the other
- LOSES TEARS, keratin becomes opaque and blincness ensues
1. Symblepharons (Adhesions)
2. Entropian (scarring/eyelids turn inward)
3. Trichiasis (eyelashes rub cornea and globe and scarring closes openings of lacrimal
glands)
Pemphigoid vs. Pemphigus - ANSWER: Pemphigoid = D = DEEPER (subepithelial
separation) than pemphigus S = SURFACE (intraepithelial separation)
- Pemphigus is more ragged, thinner
What are the three eye lesion symptoms of BMMP? - ANSWER: 1. Symblepharons
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