Diseases of the skin

• important subdivision of the practice of medicine not only because of the many primary diseases that affect the skin, but also because of the common cutaneous manifestations of deeper visceral or systemic diseases.

  Diseases of the skin
• well aware of any primary cutaneous diseases also involve the mucous membranes throughout the body, including the oral mucosa

  DERMATOLOGISTS
• one large group that represent hereditary skin disorders

  GENODERMATOSES
• alterations in the normal keratinization process

  GENOKERATOSES
• large, heterogeneous group of inherited disorders, the manifestations of which could be seen in more than one ectodermal derivatives

  ECTODERMAL DYSPLASIA SYNDROME
• manifest anodontia or oligodontia, complete or partial absence of teeth, with frequent malformation of any teeth present, both deciduous and permanent dentitions

  ECTODERMAL DYSPLASIA SYNDROME
• Most common syndromes of ECTODERMAL DYSPLASIA SYNDROME

  1. Hidrotic ED (Clouston syndrome)
  2. Hypohidrotic (anhidrotic) ED (Christ-SiemensTouraine syndrome)
• Syndrome of Ectodermal dysplasia syndrome without specific dental defect

  Hidrotic ED (Clouston syndrome)
• Syndrome of ectodermal dysplasia syndrome that has anodontia or oligodontia and malformation of any teeth present

  Hypohidrotic (anhidrotic) ED

  (Christ-SiemensTouraine syndrome)
• CHONDROECTODERMAL DYSPLASIA is an uncommon disease
• CHONDROECTODERMAL DYSPLASIA is inherited as an autosomal recessive chaoracteristic
• fusion of the middle portion of the upper lip to the maxillary gingival margin eliminating the normal mucolateral sulcus

  CHONDROECTODERMAL DYSPLASIA
• A disease manifested with bilateral white striations, papules, or plaques on the buccal mucosa, tongue, and gingivae

  ORAL LICHEN PLANUS
• ORAL LICHEN PLANUS: T-cell-mediated autoimmune disease in which cytotoxic CD8+ T-cells trigger the apoptosis of oral epithelial cells and

  may be induced by drugs (lichenoid drug reaction)
• association of lichen planus to diabetes mellitus and vascular hypertension

  Grinspan’s syndrome
• Oral manifestation over the buccal mucosa in Oral Lichen Planus

  • Striae of Wickham-tiny white elevated dot
  • Vesicle and bulla formation
• Forms of Oral Lichen Planus:

  1.Bullous - vesicles not ruptured

  2.Erosive - vesicles rupture

  3.Atrophic- smooth red lesion

  4.Hypertrophic - elevated white lesion

  5.Idiopathic - cause cannot be identified
• Small, sharply delineated, dry papules, each covered by a delicate silvery scale which resembles thin layer of Mica

  Psoriasis
• Psoriasis commonly occurring on scalp, trunk and limbs.
• Auspit’z sign

  psoriasis
• Psoriasis is more severe in winter than in summer
• Auspit’z sign in psoriasis

  
• Psoriasis has strong association with HLA Cw6 and B57 region
• lesions are associated with increased activity of T-cells in underlying skin


  psoriasis
• psoriasis could be stress-related disease
• Psoriasis histologic features:

  • Uniform parakeratosis
  • Absence Of stratum granulosum
  • Elongation and clubbing of the rete pegs
  • Monro’s abscesses
• Psoriasis rarely affects the oral mucosa
• Psoriasis oral manifestation: lesions on the tongue similar to geographic tongue and Reiters syndrome
• In psoriasis, lesions are seen on lips, buccal mucosa, palate, gingiva and floor of mouth
• In psoriasis, Gray or yellowish-white plaque; as silvery white, scaly lesions with an erythematous base; as multiple papular eruptions which may be ulcerated; or as small, papillary, elevated lesions with a scaly surface.
• psoriasis

  
• Pityriasis rosea is common in hot, dry climate countries
• pityriasis rosea most patients develop one plaque ( Herald patch) before the others
• pityriasis rosea affects mainly on trunk, but some also on the neck and extremities
• Disease has rash on the back may have a “ Christmas tree” pattern”

  Pityriasis Rosea
• oral lesions of Pityriasis Rosea

  usually occur only on the buccal mucosa, although both tongue and palatal lesions have also been recorded.
• Pityriasis rosea oral manifestation appear as erythematous macules with or without a central area of grayish desquamation
• Acute self limiting dermatitis characterized by distinctive clinical eruption manifested as the iris or target lesion


  Erythema multiforme
• concentric ring like appearing lesions , resulting from varying shades of erythema - target, iris, bulls - eye lesion


  erythema multiforme
• Spectrum of severity of Erythema Multiforme

  1. EM minor
  2. EM major
  3. Steven-Johnson Syndrome (SJS)
  4. Toxic Epidermal Necrolysis (TEN)