1. 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

2. stratified squamous epithelium
Oral mucosa
Skin

4. Congenital
Acquired

5. Pigmented
White lesions
Red lesions
Swellings
Ulcers
Blisters
Teeth anomalies

6. Importance Common Serious First manifestation
Associations- cross referrals

7. Lichen planus

8. Reticular
Erosive
Bullous
Atrophic
Plaque-form
papular

9. 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

10. Chlorhexidine mouth wash
Betnesol mouth rinses 0.5mg in 10ml
Calcineurin inhibitors
Oral steroids
Hydroxychloroquine
MMF Azathioprine, dapsone, Mtx
Rituximab

11. Importance Associated scarring- microstomia Risk of malignancy
Related to amalgum/HCV/drugs
Associations:
Skin
Vulva
Eyes
Ears

12. 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

13. Used to be fatal now 5-15%
Steroids
Azathioprine
MMF
Rituximab
Complete remission ?10 years in 75%

14. Importance
Associations: eye , genital, skin
Paraneoplastic pemphigus

16. Oral Apthae

17. Behcet Disease

18. Importance Associations Genital ulcers Ocular manifestations Aneurysms
Coagulapathy
GI/CNS

19. Importance Rule out allergens
Differentials: TB, sracoidosis, crohn’s disease
Can become permanent

20. Erythema Multiforme EM minor EM minor with extramucosal involvement
SJS- Stevens Johnson Syndrome
TEN- toxic epidermal necrolysis
Infection- HSV, mycoplasma
Drug- anticonvulsants

21. SCORTEN

22. Importance EM- common TEN- Fatal Need to stop offending drug
Sequelae ie scarring
Supportive
Immunomodulation IVIG

23. Importance Associations: Scarring Systemic involvement
Antiphospholipid syndrome