Ulcerative Conditions (PDF)

ULCERATIVE CONDITIONS  REACTIVE FUNGAL -TRAUMATIC -DEEP FUNGAL INFECTIONS -SUBCUTANEOUS FUNGAL INFECTIONS:SPOROTRICHOSIS BACTERIAL -OPPORTUNISTIC FUNGAL -SYPHILIS INFECTIONS: -GONORRHEA MUCORMYCOSIS(PHYCOMYCOSIS) A...

ULCERATIVE CONDITIONS  REACTIVE FUNGAL -TRAUMATIC -DEEP FUNGAL INFECTIONS -SUBCUTANEOUS FUNGAL INFECTIONS:SPOROTRICHOSIS BACTERIAL -OPPORTUNISTIC FUNGAL -SYPHILIS INFECTIONS: -GONORRHEA MUCORMYCOSIS(PHYCOMYCOSIS) AND ASPERGILLOSIS -TUBERCULOSIS -LEPROSY -ACTINOMYCOSIS -NOMA  REACTIVE rises in response to mechanical, chemical, thermal, or other forms of trauma. These ulcers are not due to systemic disease but rather to external factors that injure the tissue.  TRAUMATIC ULCERATIONS 1. ACUTE REACTIVE ULCERS – pain, redness, swelling; covered by a yellow-white fibrinous exudate and surrounded by an erythematous halo 2. CHRONIC REACTIVE ULCERS – little to no pain; covered by a yellow membrane and surrounded by elevated margins that may show keratosis; induration due to scar formation and chronic inflammatory cell infiltration -Caused by trauma, chemicals, heat and radiation -self-limiting TX: -bland mucolytic mouth rinse(sodium bicarbonate in warm water)-helps keep the ulcer clean -Topical corticosteroid for pain  BACTERIAL INFECTIONS ulcers caused by bacterial infections that lead to tissue destruction and localized necrosis.  SYPHILIS CA: Treponema pallidum PRIMARY SYPHILIS – painless ulcers with rolled margins at the site of inoculation; no exudate; regional lymphadenopathy(firm, painless swelling); chancre SECONDARY SYPHILIS – begins after about 2-10 weeks; mucous patches; condyloma lata TERTIARY SYPHILIS – predilection for cardiovascular system and CNS; gumma CONGENITAL SYPHILIS - abnormal shape of molars/incisors, deafness, ocular keratitis, skeletal defects TX: DOC: Penicillin Azithromycin-alternative choice  GONORRHEA CA: Neisseria gonorrhoeae Oral Gonorrhea – generalized erythema and multiple ulcerations Pharyngeal Gonorrhea – general erythema and ulcers with cervical lymphadenopathy; chief complaint: sore throat TX: PARENTERAL AMPICILLIN  TUBERCULOSIS CA: Mycobacterium tuberculosis indurated, chronic, nonhealing ulcer that is usually painful Tuberculosis osteomyelitis Microscopic: granulomas that show central caseous necrosis TX: RIPES R -Rifampicin I - Isoniazid P - Pyrazinamide E - Ethambutol S - Streptomycin  LEPROSY CA: Mycobacterium leprae TX:dapsone, rifampin, clofazimine, and minocycline. The known teratogen thalidomide is useful for managing the complications of leprosy therapy, as are thalidomide analogs  ACTINOMYCOSIS CA: Actinomyces israelii May be preceded by trauma or direct extension of a contagious infection CERVICOFACIAL ACTINOMYCOSIS-mandibular swelling that simulates a pyogenic infection Maxilla is less commonly involved, may result in an osteomyelitis that may drain through the gingiva via a sinus tract Sulfur granules-aggregates of A. israelii TX: Penicillin  NOMA CA: Anaerobes in immunocompromised patients Typically affects children Noma neonatorum Denudation of involved bone may follow, eventually leading to necrosis and sequestration. Teeth in the affected area may become loose and exfoliate TX: treating the underlying predisposing condition, and the infection itself Therefore fluids, electrolytes, and general nutrition are restored. Antibiotics of choice include clindamycin, piperacillin, and the aminoglycoside gentamicin -Debridement of necrotic tissue -reconstructive surgery FUNGAL INFECTIONS  DEEP FUNGAL INFECTIONS Histoplasma capsulatum, coccidioides immitis, others skin eruption resembling erythema multiforme occasionally appears concomitantly with coccidioidomycosis infection. TX: ketoconazole, fluconazole, and amphotericin B  Subcutaneous Fungal Infections: Sporotrichosis CA: Sporothrix schenckii usually follows inoculation via thorny plants red nodules appear, with subsequent breakdown, exudate production, and ulceration Orally, lesions typically present as nonspecific chronic ulcers. Lymphadenopathy may also be present TX: solution of saturated potassium iodide less commonly, with systemic antifungal agents In cases of toxicity or allergy to iodides, ketoconazole has been used with limited success.  Opportunistic Fungal Infections: Mucormycosis(Phycomycosis)and Aspergillosis CA: Mucormycosis, Rhizopus, others tissue necrosis may result in perforation of the palate Extension into the orbit or brain is a common complication may mimic syphilis, midline granuloma, TX: Lipid-based formulations of amphotericin B are the drugs of choice