STUDY - Technical - New Dacian's Medicine
Diseases
of the Oral Mucosa (2)
Translation Draft
I will continue yesterday's presentations with dermatological conditions that manifest at this level. I will start with the pemphigoid of the mucous membranes that can be "met" especially in the mucosa of the oral cavity, but it can also affect the eyes, urethra, vagina and rectum.
It is manifested by blisters or bubbles colabate, painful, gray-white with erythematous peripheral area, the gum lesions descuaming, leaving an ulcerated surface. Evolution is prolonged, with remissions and exacerbations, affecting the various regions occurring slowly. Glucocorticoids may temporarily reduce symptoms, but do not control the disease.
Another "problem" is polymorphic erythema (Stevens-Johnson syndrome) which can be found especially in the oral mucosa and skin of the hands and feet. It manifests itself in broken intrabucal bubbles, surrounded by an inflammatory area. Lips may have hemorrhagic crusts, and the "iris" or "target" lesion on the skin is pathognomonic. The patient may show serious signs of toxicity. The onset is very fast and the condition can last 1-2 weeks and can be fatal. Acute episodes respond to steroids.
Pemphigus vulgaris is another condition that manifests itself in the oral mucosa and skin, through broken bubbles and ulcerated surfaces, especially in elderly adults. There's something else to say about the plan lichen, "present" in the oral mucosa and skin. It is manifested by white streaks in the oral cavity, purple nodules on the skin in the areas of friction and sometimes causes mucous ulceration and erosive gingivitis. Evolution is prolonged and may respond to topical steroids.
Other conditions are represented by... Recurrent foot-and-mouth ulcers, which manifest themselves anywhere in the nekeratinized oral mucosa (lips, tongue, oral mucosa, oral floor, soft palate and oropharynx) through isolated or grouped painful ulcers with surrounding erythematous edge. Injuries can be 1-2 mm in diameter, arranged in bunches (herpetiforms), 1-5 mm (minor) or 5-15 mm (major). Injuries heal in 1-2 weeks, but can recur monthly or several times a year. Topical steroids give symptomatic improvements, in severe cases systemic glucocorticoid therapy may be necessary. An oral suspension of tetracycline may reduce the severity of herpetiform ulcers.
Another condition would be Behcet syndrome, "present" in the oral mucosa, eyes, genitals, intestine and CNS. It is manifested by multiple foot-and-mouth ulcers in the oral cavity, inflammatory eye changes, ulcerative lesions in the genital organs, inflammatory bowel disease and CNS disorders. Ulcerations can persist for several weeks and heal without scarring.
Finally we can talk about traumatic ulcers, "present" in anywhere in the mucosa of the oral cavity (dental prostheses are frequently responsible for ulcers at the vestibular level). It is manifested by discrete, localized ulcerated lesions with red edge, produced by accidental bites of the mucosa, penetration of a foreign body or chronic irritation due to a denture. Injuries usually heal within 7-10 days if the irritant is removed, provided that no overinfection occurs.
It's time for the discussion of the pigmentation lesions of the oral mucosa. The oral melanotic macula is present in any area of the oral cavity and is manifested by a discrete or diffuse localized macula, brown to black that persists indefinitely. Diffuse melaninpigmentation is also present in any area of the oral cavity and is manifested by diffuse pigmentation, pale to dark brown (may be physiological ("racial") or due to smoking), persisting indefinitely.
Nevi can occur, like any pigmentation lesion of the oral mucosa, in any area of the oral mucosa, manifested by discrete, localized pigmentation, brown to black, which persists indefinitely.
Malignant melanoma can be flat and diffuse, painless, brown to black or can be elevated and nodular, expanding and invading early (metastases lead to exitus).
Addison's disease occurs mainly in the oral mucosa and is manifested by black to dark brown drops or pigmentation spots, which appear early in the course of the disease, accompanied by diffuse skin pigmentation (there are also signs of adrenal insufficiency). The disease is controlled by steroid treatment.
Peutz-Jeghers syndrome is manifested by dark brown spots on the lips, the oral mucosa, with a characteristic distribution of pigment around the lips, nose, eyes and hands, including concomitant intestinal polyposis. The pigmentation lesions persist indefinitely and polyposis can be malignant. Drug ingestion (tranquilizers, oral contraceptives, antimalarials) and causes brown, black or grey areas of pigmentation. Disappear after discontinuation of the drug.
Amalgam tattooing occurs mainly in the gums and mucobucal sachets and is manifested by small black-blue areas of pigmentation associated with amalgam particles embedded in soft tissues (these may appear as radioopaque particles on X-rays in some cases), persisting indefinitely.
Pigmentation due to heavy metals (bismuth, mercury, lead) occurs mainly on the gum edge and is manifested by black-blue pigmented line along the gum line due to previous treatment with bismuth or mercury for syphilis absorption or accidental lead, which persists indefinitely. The black hairy line appears on the back of the tongue and is manifested by the elongation of the filiform lingual papillae which acquires a brown to black coloration, persisting for a long time (even if it can disappear spontaneously).
At the end of this type of disease we can talk about Fordyce's "disease" present in the oral mucosa which is manifested by the aggregation of numerous small, yellowish spots, just below the surface of the mucosa, asymptomatic, due to hyperplasia of the sebaceous glands. Persists indefinitely without apparent changes.
Let's move on to the white lesions of the oral mucosa. I will start with the plan lichen that is present in the oral mucosa, tongue, gums and lips, as well as in the skin and manifests itself through striae, white plaques, red surfaces, ulcers in the oral cavity and purple papules on the skin. It can be asymptomatic, sensitive or painful. Medicinal reactions lichenoid may look similar. Evolution is prolonged and responds to topical steroids.
The white spongy nebula can be present in the oral mucosa, vagina and mucosa and is manifested by white, painless thickening of the epithelium, with onset in adolescence or early in adult (familial) life. It's benign and permanent. Smoker's leukoplakia and smoke-in-indeterminate tobacco lesions are present in any area of the oral mucosa, sometimes correlated with the exposed area and are manifested by white stain that can become firm, rough, red, cracked and ulcerated. It can become sensitive and painful, but it is usually painless and, evolutionaryly, sometimes premalignant and may or may not disappear after smoking cessation.
Nicotinic stomatitis occurs at the palate level in pipe smokers, manifested by white nodular elevations with red central areas, at the level of the hard palate. It is benign and usually disappears when the pipe is stopping.
Friction keratosis occurs in any area of the oral cavity and is manifested by elevated white lesion, due to hyperkeratosis and thickening of the oral epithelium secondary to chronic irritation. Removal of the irritant leads to healing in 2-3 weeks.
Candidiasis ("candidosis", "moniliasis") is present in any area of the oral cavity. From the point of view of manifestations it has several forms: 1. the pseudomembranous type ("afta") is manifested by creamy, cheesy white spots, which leave a rough, bleeding surface when removed. It occurs in sick infants, debilitated elderly patients treated with high doses of glucocorticoids or broad-spectrum antibiotics, or in AIDS patients, responding favourably to antimycotic treatment and correction of predisposing causes, where possible, 2. the erythematous type is manifested by flat, red, sometimes sensitive surfaces that occur in the same groups of patients, with the same evolution as for the pseudomembranous type, 3. candidosis leukoplakia is manifested by white thickening of the epithelium, which cannot be removed, produced by Candida, responding to prolonged antimycotic treatment and 4. Angular cheilitis is manifested by painful cracks in the oral comisure that respond to topical antimycotic preparations.
Hairy leukoplakia usually occurs on the lateral edges of the tongue, rarely in another area of the oral mucosa. It is manifested by white surfaces ranging from small and flat to extensive and "hairy" and are found in HIV carriers in all risk groups for AIDS. Rarely causes discomfort, is due to VEB, many patients develop AIDS and respond to high doses of acyclovir, but relapses.
There would also be chemical burns occurring in any area of the oral cavity and manifested by white detritus due to necrosis of the epithelium and underlying connective tissue due to local contact with agents (e.g. aspirin) or the use of undiluted sodium perborate or oxygenated water as mouthwash. Removal of detritus leaves a rough, painful surface. The lesions heal in a few weeks if they do not overinfect.
That's it for today!
I will continue yesterday's presentations with dermatological conditions that manifest at this level. I will start with the pemphigoid of the mucous membranes that can be "met" especially in the mucosa of the oral cavity, but it can also affect the eyes, urethra, vagina and rectum.
It is manifested by blisters or bubbles colabate, painful, gray-white with erythematous peripheral area, the gum lesions descuaming, leaving an ulcerated surface. Evolution is prolonged, with remissions and exacerbations, affecting the various regions occurring slowly. Glucocorticoids may temporarily reduce symptoms, but do not control the disease.
Another "problem" is polymorphic erythema (Stevens-Johnson syndrome) which can be found especially in the oral mucosa and skin of the hands and feet. It manifests itself in broken intrabucal bubbles, surrounded by an inflammatory area. Lips may have hemorrhagic crusts, and the "iris" or "target" lesion on the skin is pathognomonic. The patient may show serious signs of toxicity. The onset is very fast and the condition can last 1-2 weeks and can be fatal. Acute episodes respond to steroids.
Pemphigus vulgaris is another condition that manifests itself in the oral mucosa and skin, through broken bubbles and ulcerated surfaces, especially in elderly adults. There's something else to say about the plan lichen, "present" in the oral mucosa and skin. It is manifested by white streaks in the oral cavity, purple nodules on the skin in the areas of friction and sometimes causes mucous ulceration and erosive gingivitis. Evolution is prolonged and may respond to topical steroids.
Other conditions are represented by... Recurrent foot-and-mouth ulcers, which manifest themselves anywhere in the nekeratinized oral mucosa (lips, tongue, oral mucosa, oral floor, soft palate and oropharynx) through isolated or grouped painful ulcers with surrounding erythematous edge. Injuries can be 1-2 mm in diameter, arranged in bunches (herpetiforms), 1-5 mm (minor) or 5-15 mm (major). Injuries heal in 1-2 weeks, but can recur monthly or several times a year. Topical steroids give symptomatic improvements, in severe cases systemic glucocorticoid therapy may be necessary. An oral suspension of tetracycline may reduce the severity of herpetiform ulcers.
Another condition would be Behcet syndrome, "present" in the oral mucosa, eyes, genitals, intestine and CNS. It is manifested by multiple foot-and-mouth ulcers in the oral cavity, inflammatory eye changes, ulcerative lesions in the genital organs, inflammatory bowel disease and CNS disorders. Ulcerations can persist for several weeks and heal without scarring.
Finally we can talk about traumatic ulcers, "present" in anywhere in the mucosa of the oral cavity (dental prostheses are frequently responsible for ulcers at the vestibular level). It is manifested by discrete, localized ulcerated lesions with red edge, produced by accidental bites of the mucosa, penetration of a foreign body or chronic irritation due to a denture. Injuries usually heal within 7-10 days if the irritant is removed, provided that no overinfection occurs.
It's time for the discussion of the pigmentation lesions of the oral mucosa. The oral melanotic macula is present in any area of the oral cavity and is manifested by a discrete or diffuse localized macula, brown to black that persists indefinitely. Diffuse melaninpigmentation is also present in any area of the oral cavity and is manifested by diffuse pigmentation, pale to dark brown (may be physiological ("racial") or due to smoking), persisting indefinitely.
Nevi can occur, like any pigmentation lesion of the oral mucosa, in any area of the oral mucosa, manifested by discrete, localized pigmentation, brown to black, which persists indefinitely.
Malignant melanoma can be flat and diffuse, painless, brown to black or can be elevated and nodular, expanding and invading early (metastases lead to exitus).
Addison's disease occurs mainly in the oral mucosa and is manifested by black to dark brown drops or pigmentation spots, which appear early in the course of the disease, accompanied by diffuse skin pigmentation (there are also signs of adrenal insufficiency). The disease is controlled by steroid treatment.
Peutz-Jeghers syndrome is manifested by dark brown spots on the lips, the oral mucosa, with a characteristic distribution of pigment around the lips, nose, eyes and hands, including concomitant intestinal polyposis. The pigmentation lesions persist indefinitely and polyposis can be malignant. Drug ingestion (tranquilizers, oral contraceptives, antimalarials) and causes brown, black or grey areas of pigmentation. Disappear after discontinuation of the drug.
Amalgam tattooing occurs mainly in the gums and mucobucal sachets and is manifested by small black-blue areas of pigmentation associated with amalgam particles embedded in soft tissues (these may appear as radioopaque particles on X-rays in some cases), persisting indefinitely.
Pigmentation due to heavy metals (bismuth, mercury, lead) occurs mainly on the gum edge and is manifested by black-blue pigmented line along the gum line due to previous treatment with bismuth or mercury for syphilis absorption or accidental lead, which persists indefinitely. The black hairy line appears on the back of the tongue and is manifested by the elongation of the filiform lingual papillae which acquires a brown to black coloration, persisting for a long time (even if it can disappear spontaneously).
At the end of this type of disease we can talk about Fordyce's "disease" present in the oral mucosa which is manifested by the aggregation of numerous small, yellowish spots, just below the surface of the mucosa, asymptomatic, due to hyperplasia of the sebaceous glands. Persists indefinitely without apparent changes.
Let's move on to the white lesions of the oral mucosa. I will start with the plan lichen that is present in the oral mucosa, tongue, gums and lips, as well as in the skin and manifests itself through striae, white plaques, red surfaces, ulcers in the oral cavity and purple papules on the skin. It can be asymptomatic, sensitive or painful. Medicinal reactions lichenoid may look similar. Evolution is prolonged and responds to topical steroids.
The white spongy nebula can be present in the oral mucosa, vagina and mucosa and is manifested by white, painless thickening of the epithelium, with onset in adolescence or early in adult (familial) life. It's benign and permanent. Smoker's leukoplakia and smoke-in-indeterminate tobacco lesions are present in any area of the oral mucosa, sometimes correlated with the exposed area and are manifested by white stain that can become firm, rough, red, cracked and ulcerated. It can become sensitive and painful, but it is usually painless and, evolutionaryly, sometimes premalignant and may or may not disappear after smoking cessation.
Nicotinic stomatitis occurs at the palate level in pipe smokers, manifested by white nodular elevations with red central areas, at the level of the hard palate. It is benign and usually disappears when the pipe is stopping.
Friction keratosis occurs in any area of the oral cavity and is manifested by elevated white lesion, due to hyperkeratosis and thickening of the oral epithelium secondary to chronic irritation. Removal of the irritant leads to healing in 2-3 weeks.
Candidiasis ("candidosis", "moniliasis") is present in any area of the oral cavity. From the point of view of manifestations it has several forms: 1. the pseudomembranous type ("afta") is manifested by creamy, cheesy white spots, which leave a rough, bleeding surface when removed. It occurs in sick infants, debilitated elderly patients treated with high doses of glucocorticoids or broad-spectrum antibiotics, or in AIDS patients, responding favourably to antimycotic treatment and correction of predisposing causes, where possible, 2. the erythematous type is manifested by flat, red, sometimes sensitive surfaces that occur in the same groups of patients, with the same evolution as for the pseudomembranous type, 3. candidosis leukoplakia is manifested by white thickening of the epithelium, which cannot be removed, produced by Candida, responding to prolonged antimycotic treatment and 4. Angular cheilitis is manifested by painful cracks in the oral comisure that respond to topical antimycotic preparations.
Hairy leukoplakia usually occurs on the lateral edges of the tongue, rarely in another area of the oral mucosa. It is manifested by white surfaces ranging from small and flat to extensive and "hairy" and are found in HIV carriers in all risk groups for AIDS. Rarely causes discomfort, is due to VEB, many patients develop AIDS and respond to high doses of acyclovir, but relapses.
There would also be chemical burns occurring in any area of the oral cavity and manifested by white detritus due to necrosis of the epithelium and underlying connective tissue due to local contact with agents (e.g. aspirin) or the use of undiluted sodium perborate or oxygenated water as mouthwash. Removal of detritus leaves a rough, painful surface. The lesions heal in a few weeks if they do not overinfect.
That's it for today!
Have a good day!
Dorin, Merticaru