What’s the link? Shared embryological origin (ectoderm +/- enoderm) Shared functions Continuation of the skin First manifestation of dermatological conditions Essential part of dermatological examination
stratified squamous epithelium Oral mucosa Skin
Congenital Acquired
Pigmented White lesions Red lesions Swellings Ulcers Blisters Teeth anomalies
Importance Common Serious First manifestation Associations- cross referrals
Lichen planus
Reticular Erosive Bullous Atrophic Plaque-form papular
0.2% of populations 25% skin and oral LP- erosive, lichenoid HCV, amalgam, GvHD Drugs; B-blockers, calcium channel blockers, NSAIDS, ACE-inihibitors Mostly buccal mucosa and lateral tongue Symmetrical Lasts longer than skin lesions average 8 years Can be asymptomatic
Chlorhexidine mouth wash Betnesol mouth rinses 0.5mg in 10ml Calcineurin inhibitors Oral steroids Hydroxychloroquine MMF Azathioprine, dapsone, Mtx Rituximab
Importance Associated scarring- microstomia Risk of malignancy Related to amalgum/HCV/drugs Associations: Skin Vulva Eyes Ears
DSG3 +/- DSG1 Earlier mucosal involvement 50-70% (average 5 months) Drugs- anti-TB, ACE inhibitors, captopril, rifampicin Less intact vesicles or bullae Irregular ulcers- ginigivae, buccal, palatal areas No scarring
Used to be fatal now 5-15% Steroids Azathioprine MMF Rituximab Complete remission ?10 years in 75%
Importance Associations: eye , genital, skin Paraneoplastic pemphigus
Oral Apthae
Behcet Disease
Importance Associations Genital ulcers Ocular manifestations Aneurysms Coagulapathy GI/CNS
Importance Rule out allergens Differentials: TB, sracoidosis, crohn’s disease Can become permanent
Erythema Multiforme EM minor EM minor with extramucosal involvement SJS- Stevens Johnson Syndrome TEN- toxic epidermal necrolysis Infection- HSV, mycoplasma Drug- anticonvulsants
SCORTEN
Importance EM- common TEN- Fatal Need to stop offending drug Sequelae ie scarring Supportive Immunomodulation IVIG
Importance Associations: Scarring Systemic involvement Antiphospholipid syndrome