3. Introduction
• Few basic principles – critical in understanding
the interpretation of physical signs
• These principles arise from the morphological &
functional diff of the 3 main levels of the skin
Epidermis
Dermis
S/C fat
4. Discrete flat lesion, not raised above the adjacent
normal skin
Large macule – patch
Size limit at which a macule becomes a patch
varies in diff texts – 1.5-2cms
Usually darker red or brown than normal skin,
5. Papules & nodules –
Discrete lesions – usually visibly raised above the
skin surface
Nodules – may also lie deep to the dermis –
lipoma
Size at which the a papule should be called a
nodule – varies 5-10mm
All nodules starts as papules but not all papules
will grow into nodules
6. Plaques –
Raised lesion with a flat top
Scaling frequently present
E.G – lesions of psoriasis
7. Vesicles & bullae –
Both terms – describe diff sizes of blister
Discrete accumulation of fluid – components run out when top is incised
Occur within or just below the epidermis
Vesicle is small & blister is large – cut off –
5-10mm
Useful to note the size range
8. Pustules –
Epidermal or upper dermal accumulation of pus – breakdown product of PMNL
Clinically – yellow or green
Deeper collection of pus –abscess – but the
content not visible through the skin
Some pustules – infiltration of PMNL
few – start as vesicle & gradually accumulat
pus cells
9. Erythema, telangiectasia, purpura, petechiae & ecchymosis
Terms – describe vascular changes
Erythema – diffuse redness due to increased
Visibility of I/V blood – due to vasodilatation
Telangiectasia – individually visible dilated
vessels
Purpura – visible extravascular blood
If this occurs – tiny pinpoint spots – petechiae
Large area of extravasated blood – ecchymosis
12. Ectodermal dysplasia
Relatively rare
X linked recessive inheritance pattern
c/f –
Soft, smooth dry skin – partial or total loss of sweat glands
Cannot perspire – unexplained high temp
Sebaceous glands & hair follicles – absent
Hair of the scalp & eyebrows – fine, scanty
Bridge of the nose is depressed
Frontal bossing
Lips become protruberant
13.
14. Oral manifestations
Anodontia or Oligodontia
Malformation of both deciduous & permanent teeth
Truncated or cone shape
Jaws will be normal but the alveolar process will not develop in the absence
of teeth – reduced vertical dimension – protuberant lips
High palatal arch & cleft palate may be present
Salivary glands – hypoplastic – xerostomia
Hypolasia of nasal & pharyngeal mucous glands – pharyngitis/ rhinitis
15.
16. Treatment & prognosis
No treatment
For dental problems – prosthetic replacement of dentition
17. White sponge nevus / Cannon’s
disease
Genodermatologic disease
Autosomal dominant trait
Etiology –
Due to defective normal keratinisation of oral mucosa
Keratins 4 & 14 specifically expressed in spinous layers
18. c/f –
Appears at birth or in early childhood’
Symmetric thickened, white corrugated or velvety, diffuse plaque
Affects BM –b/l
Other sites – ventral tongue, labial mucosa, soft palate & alveolar mucosa
24. Treatment & prognosis
Benign condition – no treatment
If superinfected with candidal infection – antifungal therapy
25. Darier’s disease (keratosis follicularis)
Rare genodermatosis – striking skin involvement
Autosomal dominant trait
Lack of cohesion among the surface epith cells –
characteristic
Mutation in genes coding intracellular pump –
identified as the cause for abnormal desmosomal
organization in affected epith cells
26. C/F –
Erythematous, often pruritic, papules – skin of trunk & scalp
•Accumulation of keratin – rough texture
•Gen becomes worse during summer – due to
sensitivity of patient to UV light
•Palms & soles exhibits pits & keratoses – nails
show longitudinal line
27. Oral lesions –
Consists of multiple, normal colored or white, flat topped papules – cobble stone
appearance
t
h
e
s
e
Lesions affect – hard palate, alveolar mucosa
Primarily others b. mucosa & tongue
28. H/P –
Shows dyskeratotic process characterized by
Central keratin plug that overlay epith
exhibiting a suprabasilar cleft
Intraepithelial clefting phenomenon –
acantholysis
Rete ridges – narrow, elongated & test tube
Shaped
2 types of dyskeratotic cells –
Corps ronds – dyskeratotic basophilic mass
surrounded by eosinophilic cytoplasm
grains – elongated parakeratotic cells
29. Treatment
Depends on the severity of the disease
For mild cases – keratolytic agents
Severe cases – systemic retinoids
Condition is nor premalignant nor life
threatening
30. Pemphigus
Autoimmune mucocutaneous disease characterized by
intraepithelial blister formation
Due to loss of intercellular adhesion known as acantholysis
4 types of pemphigus –
P. vulgaris
P.vegetans
P. erytematosus
P. foliaceous
Affects whole epith & involves oral mucosa
Affects only prickle cell layer
32. c/f –
Pts – erosions & ulcerations covered by white or blood tinged
exudate
•Usually affects – palate, L. mucosa, B. mucosa
ventral tongue & gingivae
• pts rarely complains of vesicles or bullae
severe pain, ↑ salivation
•Most of the pts will have oral lesions before the
onset of cutaneous lesions
33.
34.
35.
36. Cicatrial pemphigoid / benign mucous
membrane pemphigoid
Term pemphigoid – clinically appears like pemphigus
Cicatrix – scar (scarring of conjunctivitis)
Group of chronic blistering, mucocutaneous autoimmune
disease in which autoantibodies are directed against any 1 or
more components of basement membrane
37. Antigenic targets – laminin 5 & 180 KD protein –
Bullous pemphigoid antigen
IgG & C3 – along with IgA, IgM – deposited along
the basement memb
38. c/f –
Age – older pts
Sex – F:M – 2:1
Site – oral lesions, involvement of conjunctiva, nasal,
Esophagus, laryngeal & vaginal mucosa
Becoz the blisters are subepith – produces a thick strong
Roof
Later – blisters rupture leaving large, superficial ulcerations,
& denuded areas of mucosa
Ulcerations – painful & persists for weeks
39.
40.
41.
42. Epidermolysis bullosa
Immunologically mediated disease in which antibodies are directed against type VII
Collagen- principle component of anchoring fibrils
Anchoring fibrils – play imp role in bonding the
Epith to underlying conn tissue
43.
44.
45.
46. Erythema Multiforme
Blistering, ulcerative, mucocutaneous condition of uncertain etiology
Probably a immunologically mediated disease – Ag – Ab complexes targeted
against small vessels in skin & mucosa
In few cases – preceding infection – herpes simplex, mycoplasma
pneumoniae
52. h/p –
Mucosa – intraepithelial or subepith
vesiculation Due to intra & inter cellular
edema
Edema results in pooling of eosinophilic
Coagulum within epith
Necrosis of basal keratinocytes
53.
54. Lupus erythematous
Immunologically mediated condition
Etiology -
Both humoral or cell mediated arms of immune systems are
involved
Genetic factors are known to play an imp role
Autoab against cellular antigens in both nucleus & cytoplasm
55. c/f –
Age – middle aged
Sex – f >m
General symptoms – fever, wt loss, fatigue
Characteristic – butterfly rash – develops over malar
Area and nose
56. Oral manifestations –
An ulcerated or atrophic, erythematous central zone surrounded by white, fine, radiating
Striae
Atrophic lesions – may be painful
57. H/P –
Hyperkeratosis
Alternating atrophy & thickening spinous layer
Degeneration of basal layer
Subepithelial lymphocytic infiltration
Lab diagnosis –
LE test – LE bodies
ANA
58. Systemic sclerosis
Rare immunologically mediated condition
Characterized by deposition of dense collagen in tissues in the body
c/f –
Age – middle age
Sex – F:M=3:1
First sign of the disease – Raynaud’s phenomenon – a vasoconstrictive event
triggered by emotional stress or exposure to cold
CREST syndrome
59. Oral manifestations
Microstomia
Dysphagia
Rad /f –
Diffuse widening of PDL space throughout the dentition
Varying degree of resorption – post ramus, coronoid process,
chin and condylar area
60. h/p –
Shows diffuse deposition of dense collagen within and around
the normal structure
Replaces almost all the normal structure of conn tissue
Treatment –
Systemic medication – D-penicillamine inhibits collagen
production
