Dermatology Quiz: Lichen Planus and EB

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Questions and Answers

What is a recommended practice when a patient is found to have lichen planus of the skin?

Disregarding oral examination since skin involvement is isolated.

Referring the patient to a dermatologist immediately.

Only treating the skin condition without further assessment.

Examining the oral mucosa regardless of symptoms. (correct)

Why is it important to refer a lichen planus patient to the oral medicine department?

To provide cosmetic solutions for skin lesions.

To investigate any changes detected in the oral mucosa. (correct)

To prescribe medication solely for the skin condition.

To explore dietary changes that may benefit the patient.

What symptom may not be present in patients with lichen planus?

Visible skin lesions that always lead to oral symptoms.

Severe itching in the majority of cases.

Oral lesions that are always symptomatic.

Asymptomatic condition where skin is affected. (correct)

What is a possible consequence of not examining the oral mucosa in lichen planus patients?

Missed identification of asymptomatic lichen planus changes. (A) Signup and view all the answers

How should healthcare professionals approach lichen planus management?

Integrate a comprehensive evaluation including oral assessment. (B) Signup and view all the answers

What is the primary issue in Epidermolysis Bullosa (EB)?

Complete absence or abnormality of Collagen VII (D) Signup and view all the answers

How does the absence of Collagen VII affect the skin layers?

It allows the epidermis and dermis to easily separate (D) Signup and view all the answers

What characteristic distinguishes the blisters seen in Epidermolysis Bullosa from those in pemphigus?

Blisters in EB are deep and intact, unlike the eroded form of pemphigus (C) Signup and view all the answers

What occurs to the area of the skin affected by the blisters in Epidermolysis Bullosa after they slough?

It becomes eroded (B) Signup and view all the answers

In the context of Epidermolysis Bullosa, what role does Collagen VII play?

It serves as the glue between the epidermis and dermis (D) Signup and view all the answers

Which condition is typically associated with infections as its common cause?

Erythema Multiforme (EM) (D) Signup and view all the answers

What is the primary cause of Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome (SJS)?

Drugs (D) Signup and view all the answers

What is a key reason for the importance of early recognition and treatment of TEN and EM?

To avoid scarring of eyes and nails (C) Signup and view all the answers

What immediate action should be taken upon identifying the cause of TEN or SJS?

Discontinue the offending drug (B) Signup and view all the answers

What are potential sequelae of untreated TEN or EM?

Inflammation and blistering leading to scarring (C) Signup and view all the answers

What can occur if a certain condition is left untreated and mucosal involvement is present?

Development of dysplastic changes (D) Signup and view all the answers

In severe untreated cases involving the genital and oral mucosae, what progression may occur?

Development of squamous cell carcinoma (D) Signup and view all the answers

Which factor significantly contributes to the risk of squamous cell carcinoma when a condition is untreated?

Involvement of the genital and oral mucosae (B) Signup and view all the answers

What is a potential outcome of untreated severe dysplastic changes in mucosal tissues?

Progression to malignant conditions (D) Signup and view all the answers

Which of the following statements is true regarding untreated severe mucosal involvement?

It may lead to severe dysplastic changes. (D) Signup and view all the answers

Which condition is associated with severe mucosal changes as opposed to changes in the skin?

Graft versus host disease (GvHD) (D) Signup and view all the answers

Which medication is NOT listed as a potential trigger for exacerbating mucosal issues?

Statins (D) Signup and view all the answers

What viral infection is mentioned as potentially associated with severe mucosal disease?

Hepatitis C Virus (HCV) (C) Signup and view all the answers

Which of the following medications is noted for its role in exacerbating mucosal conditions?

Beta blockers (B) Signup and view all the answers

What is the relationship between amalgam and mucosal manifestations?

Amalgam may be associated with severe mucosal conditions. (D) Signup and view all the answers

What is a potential association that should be considered in patients with orofacial granulomatosis?

Inflammatory Bowel Disease (D) Signup and view all the answers

Which condition is characterized by dryness and inflammation at the angle of the mouth?

Angular Cheilitis (C) Signup and view all the answers

Which of the following can contribute to the development of Angular Cheilitis?

Nutritional deficiencies (D) Signup and view all the answers

In what demographic may Angular Cheilitis commonly be seen due to specific behaviors?

Children who frequently lick their lips (C) Signup and view all the answers

What type of infections should be considered in the differential diagnosis of Angular Cheilitis?

Bacterial or candidal infections (C) Signup and view all the answers

Study Notes

Internal Medicine

Internal medicine is a medical specialty focused on the diagnosis and treatment of diseases and conditions affecting the internal organs.

Oral Manifestations of Skin Disease

Oral mucosa is a continuation of the skin.
Shared embryological origin (ectoderm).
Shared function as a barrier.
Oral mucosa is non-keratinized, unlike skin.
Oral mucosa lacks adnexal structures (hair follicles, sweat glands, sebaceous glands, except Fordyce's disease).
Oral mucosa contains minor salivary glands.
Oral mucosa can manifest cutaneous diseases (congenital or acquired).
Oral mucosa manifestations include pigmented, white, red lesions, swellings, ulcers, and those with tooth anomalies.
Oral mucosa involvement is a crucial clinical indicator.

Lichen Planus

A chronic, itchy skin disease characterized by papules (violaceous, polygonal, planar, flat-topped), and pruritus.
Usually lasts 3-5 years on skin.
Lichen planus can affect the oral mucosa.
Oral involvement can be the first sign of the disease.
Early detection of oral involvement is crucial for prompt treatment.
Teamwork between dermatologists and dentists is necessary.

Wickham's Striae

Lacy white appearance seen on skin and oral mucosa.
Remniscent of oral mucosa.
Important for early diagnosis and referral to dermatologists.
Can lead to scarring alopecia (hair loss) if untreated.
Can affect skin, nails, genital mucosa, and scalp if severe.

Other Important Skin Conditions (Oral Manifestations)

Prevalence is 0.2% of the population.
25% with oral involvement are erosive or lichenoid.
Possible associations with HCV, amalgam, and GvHD.
Drugs may trigger or exacerbate the condition (B-blockers, calcium channel blockers, NSAIDs, ACE inhibitors).
Buccal mucosa and lateral tongue are common affected sites.
Treatment usually involves steroids and mouth rinses tailored to severity.
Oral manifestations should alert to potential systemic diseases.

Pemphigus Vulgaris

A bullous disease characterized by the formation of blisters due to an autoimmune response.
The blisters are often soft and flaccid, and are involved in other locations besides skin.
The disease primarily shows typical appearance on the trunk, chest, back, and face.
Oral involvement is associated with a higher risk of malignancy.

Epidermolysis Bullosa (EB)

A genetic disorder that affects the skin and mucosa by weakening collagen, leading to blisters.
There are different types of EB, each with varying levels of severity.
Can result in scarring or erosions, even sloughing.
Often leads to premature death if untreated.
Oral involvement is frequent.

Oral Aphthae

Small, superficial ulcers that often resolve quickly.
Common, usually not serious, and can be stressful.

Behcet Disease

Characterized by oral ulcers, genital ulcers, ocular inflammation, and skin lesions.
Oral involvement may be unnoticed or subtle.
It includes the presence of major criteria (involving the skin, joints, eyes, and mouth) in addition to minor ones, like proteinuria and haematuria.
Incidence varies geographically.

Orofacial Granulomatosis

Characterized by episodic swelling and/or inflammation of the upper lip.
Biopsy commonly reveals granulomatous changes.
Often confused with angioedema.
Lip involvement is more prevalent than lower lip.

Lupus Erythematosus

A photosensitive condition that causes skin lesions, and scarring alopecia.
Discoid lupus is a localized form that mainly affects the skin.
There's a significant possibility of involvement in the areas of the body that are regularly exposed to sunlight.

Toxic Epidermal Necrolysis (TEN) & Stevens-Johnson Syndrome (SJS)

Severe inflammatory skin reactions, often drug-induced.
Characterized by extensive skin sloughing and mucosal involvement.
Oral involvement is frequent and often severe.
Prognosis depends on the disease severity.
Early intervention is crucial for optimal patient outcome.

Ectodermal Dysplasia

A group of genetic conditions that affect multiple systems, including teeth, hair, nails, sweat glands, and skin.
Abnormal teeth in context of abnormal hair, nails, and skin should lead to considering ectodermal dysplasia.
It can manifest in oral conditions as well as general conditions.

Scoring Systems

SCORTEN is used to assess the severity of TEN and SJS.
Age, presence of malignancy, and other clinical parameters are used to score patients.

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Description

Test your knowledge on the management and implications of lichen planus and epidermolysis bullosa (EB). This quiz covers important aspects of diagnosis, treatment approaches, and the underlying pathophysiology associated with these skin conditions. Ensure you understand the critical roles of oral examinations and collagen in skin health.