Whats the link Shared embryological origin ectoderm enoderm

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, Gv. HD 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. 5 mg in 10 ml 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

• DSG 3 +/- DSG 1 • 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 with extramucosal involvement SJS- Stevens Johnson Syndrome TEN- toxic epidermal necrolysis • Infection- HSV, mycoplasma • Drug- anticonvulsants