INFLAMMATORY DISEASES PART I Immunopathology Part I
Nonspecific & T Cell Mediated
Mucosal Inflammatory Lesions Nonspecific and Idiopathic Mucositis Hypersensitivity and Autoimmune T cell mediated Immunoglobulin mediated (autoantibodies)
NonSpecific Mucositis Pizza burn Wintergreen mints aspirin
Benign Migratory Glossitis Geographic Tongue All ages can be affected Clinical features: red circinate lesions with a white border that evolve, resolve and evolve yet again in another location. May be asymptomatic or mild burning may occur Etiology:? Histopathology: Neutrophilic infiltration of the parakeratin layer, mononuclear infiltration in the submucosa Erythema migrans is the equivalent condition that occurs on extraglossal mucosa, usually buccal mucosa and lips Tx: None
Benign Migratory Glossitis
Erythema Migrans
Foreign Body Gingivitis
Uremic Stomatitis Salivary ph Acidosis
T Cell Mediated Inflammatory Diseases
LICHEN PLANUS
Cutaneous Lichen Planus
Lichen Planus Midlife Females>Males Reticular, Atrophic/Erosive, Hypertrophic 0.5% Prevalence T cell Mediated Process Idiopathic Metal allergy Food allergy (Cinnamon) DIF - Basement membrane fibrinogen
OLP and Hepatitis C Virus Italian and Japanese patients (Gandolfo et al, JOPM 1994;23:119, Nagao et al, Eur J Clin Invest 1996;26:495) HCV is more prevalent in Southern Europe and Japan (van der Poel 1994) No association in Northern Europe/USA (Dupin et al, Ann Derm 1997;133:1052, Ingafou et al Int J Oral Maxillofac Surg 1998;27:65)
Reticular Lichen Planus Stria of Wickham
Lichen Planus Reticular Hypertrophic (Plaque form) Erosive
Erosive Lichen Planus Histopathology Sub-basal fibrinogen, DIF
Erosive Lichen Planus
Erosive Lichen Planus
Lichenoid Lesions Chronic Interface Mucositis T cell delayed, contact type IV allergy Chronic Ulcerative Stomatitis with antiepithelial nuclear antibodies Systemic drugs Au salts, antimalarials, antihypertensives Contact dental materials Hg, Ni, Acrylic Foodstuff antigens cinnamon
Patch Testing for Contact Lichenoid Lesions Positive reaction to zinc
Chronic Ulcerative Stomatitis with Antiepithelial Nuclear Antibodies Lichenoid (erosive, ulcerative) lesions clinically Painful Interface mucositis DIF IgG antinuclear antibodies
CUS with Antiepithelial Nuclear Abs Clinical Lichenoid infiltrate Antinuclear Abs
Contact Lesions Clinical Chronic interface mucositis
Cinnamon Lichenoid Stomatitis Clinical Lymphoid Aggregates
Lichen sclerosis et atrophicus Lichenoid lesion of skin or genitalia, extremely rare in oral mucosa Microscopically, there is an interface lymphocytic mucositis with extensive subepithelial hyalinized scarring
Lichen sclerosis et atrophicus tongue and lip
Recurrent Aphthae Minor Major Herpetiform Systemic Disease Associations Gluten Enteropathy B Vitamin and Folate Deficiency HIV Cyclic Neutropenia
Minor Aphthae
Recurrent Aphthae Minor Silver Nitrate
Recurrent Aphthae Major
Recurrent Herpetiform Aphthae
Agranulocytosis Idiopathic Pancytopenia/Aplastic Anemia Chemotherapy
Agranulocytosis Clinical WBC 2800 PMNS 30% LYMPHOCYTES 60% MONOCYTES 6% EOSINOPHILS 3% BASOPHILS 1%
HIV Oral Ulceration
Lupus Erythematosus Discoid form: cutaneous lesions Systemic form: cutaneous and visceral organs, renal disease (Kimmelsteil Wilson) Red, scaley lesions of skin, butterfly rash of face Autoantibodies: anti-nuclear, anti-dna DIF: IgM antibasement membrane May have other autoimmune conditions (Mixed Collagen Diseases)
Lupus Erythematosus Butterfly Rash
Lupus Erythematosus Gingival Erythema Discoid Lesion Anti-BM IgM
Autoimmune Sialadenitis Detailed in chapter on Salivary Disesaes Dry eyes (xerophthalmia) Dry mouth (xerostomia) Primary Sjogren Syndrome (sicca complex) Secondary Sjogren Syndrome Association with other autoimmune diseases such as rheumatoid arthritis, lupus, scleroderma