Dermatology Quiz: Lichen Planus and EB

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.