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Soreness and ulcers 3: due to vesiculobullous disease 2
Published on April 30, 2017 42 min
Other Talks in the Series: Oral & Maxillofacial Medicine
Lumps and bumps in the mouth and lips
- Dr. Nicholas Kalavrezos
- University College London Hospital, UK
Lumps and swellings of the salivary glands 1
- Prof. Emeritus John D. Langdon
- King’s College London, UK
Red lesions: autoimmune and malignant conditions
- Prof. James J. Sciubba
- The Johns Hopkins School of Medicine, USA
Sensory and motor deficits
- Dr. Dimitris Malamos
- National Organization of Health Service (IKA), Greece
White lesions - oral leukoplakia, a premalignant lesion
- Prof. Palle Holmstrup
- University of Copenhagen, Denmark
This is part two of the talk. This is Dr. Nikitakis talking about Vesiculobullous Diseases presenting as soreness and ulcers, and we will now focus on diseases showing occasional subepithelial blister formation which is accompanied by basal cell destruction.
These diseases include primarily lichen planus, a common oral disease. Lichen planus has to be differentiated from other similar looking diseases as well as from lupus erythematosus. We will talk about lichen planus, we will briefly mention some lichenoid reactions, and the entity called chronic ulcerative stomatitis, while the entity called graft-versus-host disease or GVHD will be covered in a different lecture of the same series.
Lichen planus is one of the most important oral diseases because it is quite common. It can be classified as an immunologically-mediated mucocutaneous disorder, the etiology of which is not very well understood. However, we believe that lichen planus is associated with a genetic predisposition, and for some patients, there may be association with emotional stress that can exacerbate disease.
In these diagrams, we see some elements of the pathogenesis of the disorder where some antigens in the epithelium are detected by Langerhans and other antigen presenting cells. These antigens are presented to the T lymphocytes and the T-cell reaction is Maimed. On the right side, we see the various T cells such as CD4+ and CD8+ are accumulating in the basement membrane zone, in the subepithelial connective tissue, or even within the epithelium causing destruction and necrosis of the basal cell layer.