oral ulcerations
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Classification:1.Infective:2.Traumatic:3.Idiopathic:RecurrentAphthousStomatitis(RAS)4.Associatedwithsystemicdisease:
Hematological GIT Behcets HIV
5.Associatedwithdermatologicaldiseases: Lichenplanus ChronicdiscoidLE Vesiculobullousdiseases
6.Neoplastic:SCC &others
Mechanical:causes,dxticcriteria,hist
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Chemical:chemicals,aspirinburn
Thermal:palate Factitious:biting,nails
Radiation:immediate&delayed
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Eosinophiliculcer:crushinjurytomuscle
Mostcommon
10-25%
Onset Gender Non-smokers Prodromalsymptoms Diagnosis
Clinicalforms:1.Minoraphthousulcer:
80%
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2.Majoraphthousulcer
2ndmostcommon
1-10butfrequently1-2atanyonetimeDuration:4-6wks/ulcerIntra-oralsitesClinically:depth,size,symptomsHealingRecurrencerate:
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6.Hematologicals:7.GITdisease:8.Allergicdisorders:
Immunological&histologicalfeatures:ImmunemechanismHumoralimmunity?T-cellreaction:Pre-ulcerativestage:SuprabasalepithelialCS,LPLymphoidCsinfiltrateepithInfiltrate°enerationofepithCsPre-ulcerativestage:CD4:CD8=2:1Ulcerativestage:1:10Healingstage:10:1
Aetiology:?,HLA-B51Youngadultmales
Majorcriteria: MinorcriteriaRAS ArthralgiaGenitalulcers GITlesionsUveitis,conjunctivitis,retinitis ThromboticvascularlesionsE.nodosum,pustular CNSlesions&macularlesions,Subcutaneousthrombophlebitis
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Classification:Intraepithelial:
AcantholyticPemphigusDariersdisease(Follicularkeratosis)Non-acantholyticViralinfections
Subepithelial:Erythemamultiforme LinearIGAdiseasePemphigoid BullouslichenplanusDermatitisherpitiformis OralbloodblistersEpidermolysisbullosa
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Pathogenesis:AutoimmunediseaseIGgtodesmosomes(desmogleinIII)Skin&MMsDIF&IDIF:fishnetpattern
Hist:MildinflammationinLPCleft-likespacesjustabovebasalcelllayerTombstonesTzanckcells
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Clinically:UncommonF,40-60,Mediterranean
Orallesions:50%initialsite,ultimatelyinvolvedinallcasesConfinedtooralcavityinsomeptsSoftpalateFragilebullous painfulerythematoussuperficialerosionswraggededgesSitesoftrauma:larger&moresymptomaticlesionsNikolskyssignFatal
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Othersites:nasopharynx,esophagus,vaginacanbeinvolvedOtherforms:Foliaceous,Vegetans
Clinically:Youngadults,M>FAbruptonsetProdromalphaseWiderangeofclinicalmanifestationsMildforms:oralskinorskinaloneSkinlesion:variable,targetoririslesion,hands&feetOrallesions:-Esp.onlipsandantmouth,erythematousvesiculobullouseruptionserosions-Circumoralcrusting
Stevens-Johnsonsyndrome:widespreadinvolvement10-14daysRecurrences
Pathogenesis:
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Unknown,spontaneousPrecipitatingfactors:sulphonamides,HSTypeII Ihypersensitivityrxn:-Depositionofimmunecomplexes(IgM&C3)insuperficialvesselsischemiaofepithDx:clinical,immunologicalfindingsarenegativeornonspecificHist:nonspecific,intraepithelial/subepithelialbullae,necroticlid,CICIinLP
Pathogenesis:AutoimmunediseaseLineardepositsofIGg&C3inBMzone
Hist:SubepithelialbullaeStartsasfocaledemaatBMwnoinflammationinLPSeparationoffullthicknessofepithelium(LaminaLucida)Neutrophils&eosinophilsin&aroundbulla,perivascularinflammationinLP
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Clinically:Elderly,F>MSeverityTwotypes:BullousPemphigoid:Skin10-20%orallesions+DIF,+IDIFin75%ofcases
MucousmembranePemphigoid:Skin:uncommon&minimalOralmucosa:
AlmostalwaysaffectedUsuallyprecedeothersitesInsomecasestheonlylesionsBullae:tense,tough(remainfewdays),bloodblisters
Erythematousareas,well-definedmargins,fewwksSlowlyhealscarring(CicatricialPemphigoid)Anywhere,desquamativegingivitisNasopharynx,larynx&esophagus
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GenitallesionsConjunctiva:bullae,erosions scarringwadhesions(symblepharon)+DIF&80%+IDIF
Rareskindisorder Itchyrashoftenovershoulders Glutensensitivity
Orallesions
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70%ofcasesErythematous,purpuric,vesicularorulcerativePalate,BM,Gingiva
Hist:MicroabscessesattipsofCTpapillaeDIF:granulardepositsofIgA&C3attipsofCTpapillae
Rare SimilartoDHbutglutensensitivity DIF :LineardepositsofIgAalongBMzone Lymphoma
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SeparationoftheepitheliumfromunderlyingCT Largeblisters extensive&oftenimmobilizingscarformation Threehereditaryforms&oneacquiredform
EB simplex: Intraepithelialbullae AD Appearsduringinfancy&improvingbypuberty Mild Sitesoffrictionortrauma Mildintraoralblisters Teethnotaffected
Junctional(gravis): AR Severeform SeparationwithinlaminaLucida Hgiclargebullaeinvolvingface,trunk&extremities,lossofnails&scarring Extensiveinvolvementofallmucosae Severehypoplasiaofteeth
Dermolytic(dystrophic)form: AD Separationbeneaththebasallamina Lesionsapparentatbirth Sitesofpressure bullae deepscars contracture
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Trismus,Ankyloglossia,obliterationofsulci Delayederuption&hypoplasiaofteeth
EB acquisita: Autoimmune:IgG&C3totypeVIIcollagenofanchoringfibers Adulthood Dermolytictype DIF:Linear,BM
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(Anginabullosahaemorrhagica,localizedoralpurpura) Spontaneousblood-filledbullae Subepithelial2-3cmin ulcer Palate Chocking Aetiology?
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