SECONDARY LESIONS

secondary lesions

due to trauma or sequelae to a primary lesion (may evolve from primary lesions)

are those lesions that are characteristically brought about by modification of the primary lesion or through natural evolution of the lesion environment

erosion

only the epidermis is lost, leaving deeper layers intact

an ulceration or loss of substance that occurs on the skin or mucous membrane

clinical features of erosion

leaves no scar when healed

loss of outer layer of the mucosa

circumscribed, linear, irregular, punctuate

seen on moist surfaces which represents the necrosis & loss of the outer layer of the mucous membrane

common causes of erosion

after traumatic wounds

secondary to vesicles, blebs

external → intake of acids

internal cause → gastric content regurgitation

examples of erosion

lichen planus

desquamative gingivitis

lichen planus

autoimmune condition that causes erosions on mucosal surfaces, leading to ulceration

desquamative gingivitis

condition where the gingiva becomes eroded and sloughs off, often as a result of autoimmune diseases.

external causes of tooth erosions

intake of acids (e.g., citrus, soda, or acid reflux).

interrnal causes of tooth erosions

bulimia, chronic vomiting

gastric content / GERD

fissures

can be moist or dry

linear crack or break from the epidermis to the dermis

are cleft and grooves in the tissue that are pathologically present

nystatic

treatment of choice for angular cheilitis

[ why? commonly caused by candida (a fungal infection), and it kills candida, treating the underlying cause ]

clinical features of fissures

maybe inflamed

linear crack, radiating

superficial or deep (dermis)

longitudinal and transverse

occurs at the mucocutaneous junction of the mouth

examples of fissures

congenital cleft

syphilitic rhagades

athlete's foot (tinea pedis)

angular cheilitis (perleche)

scrotal tongue or fissured tongue

angular cheilitis (perleche)

cracks at the corners of the mouth

often due to decreased vertical dimension or fungal infection

scrotal tongue / fissured tongue

often linked to vitamin B deficiency or pernicious anemia

may not be inflamed unless deep grooves are present, creating a breeding ground for microorganisms

syphilitic rhagades

caused by treponema pallidum

treatment: metronidazole / penicilin

fissures that occur as a result of syphilis, typically at the mouth's corners

ulcers

patient feels pain, presence of lymphadenopathy due to trauma

a deeper crater that involves the full thickness of the epithelium and reaches the connective tissue

deeper defects of the skin or mucous membrane that extend beyond the epidermis into the underlying tissue

clinical features of ulcers

base is soft or indurated (hardened)

after effect resulting in vesicles / blebs

edges are rugged, punched out appearance

extends into the dermis and has a concave shape

floor is smooth, granular, glazed, pus covered or hemorrhagic

common cause of ulcer

ill fitting dentures

trauma due to accidental toothbrushing

mouth burned by hot liquids or toothache drops

common sites of ulcers

tongue, lips

gingiva & palate

mucobuccal fold

examples of conditions that manifest oral ulcerations:

ANUG

sickle cell anemia

herpetic gingivostomatitis

recurrent apthous ulcers (RAU)

orogenital sex → lingual frenum affected

sickle cell anemia

a blood dyscrasia that shows manifestation of the oral mucosa as ulceration.

herpetic gingivostomatitis

viral infection (HSV-1) leading to painful vesicles that rupture into ulcers.

ANUG

bacterial infection causing painful, necrotic ulcers with a punched-out appearance.

recurrent apthous ulcers (RAU)

non- infectious, recurring ulcers of the oral mucosa, often associated with stress or immune response.

treatment for ulcers

heals within 10 days

remove the cause

application of kenalog in orabase (hydrocortisone)

pseudomembranous

results from the response of mucous surfaces to a necrotizing agent

cause of pseudomembranous

loss of surface epithelium

plasma exudates from the vessels & spreads to the eroded surface it coagulates & encloses a necrotic epithelium

clinical feature of pseudomembranous

a white membrane is formed

examples of pseudomembranous

ANUG

diphtheria

diphtheria

affecting the nose, skin, and throat

acute infectious disease caused by corynebacterium diphtheriae

white pseudomembrane formation, which can obstruct breathing (can extend into the trachea)

eschars

masses of dead tissue caused by burns or exposure to corrosive agents

tissue necrosis leads to dry, leathery scabs (eschars), which may later slough off, leaving an ulcer.

examples of eschars

aspirin burns

phenol burns

formocresol burns

phenol & cresol burns

dull gray to brown eschar

aspirin burn

primary lesion → erythematous macule (red, flat lesion)

progression → tissue necrosis leads to ulcer formation

differential diagnosis for eschars

Erythematous macule - flat circumscribed o Eschars-ulcer (loss of necrotic tissue)
o Eschars- pseudomembrane

desquamation

color: grayish white

shedding of epithelial elements in scales or sheets

scales

results of inflammation (dry)

a clinical feature of desquamation

it is lost due to continuous wetting by saliva in the oral cavity

examples of desquamation

leukoplakia

focal hyperkeratosis

leukoplakia

white, keratotic lesion due to chronic irritation

focal hyperkeratosis

localized thickening of the epithelium due to friction or irritation

crusts

not common in oral cavity due to the moist environment from saliva

if it is removed, it leaves a bleeding surface and may form a pseudomembrane

dried pus, blood, dried serum, epithelial debris, and external matter on skin or lips

formation process

crusts (pseudomembrane) → cracks → fissures → may bleed due to trauma, speaking, or mastication

clinical features of crusts

maybe deep seated or superficial

yellowish to brown, depending on the amount of pus or blood

constant drying of coagulated blood, tissue, fluids & debris

common sites of crusts

mucocutaneous junction of the lips (ex: angular cheilitis)

associated conditions of crusts

carcinomas

vesicular lesions

traumatic ulcers

bullous disorders