Etiology and Pathophysiology
Contributory factors :
- Completely unknown etiology but may have
- inducers of hypersensitivity
- psychological facotrs
- microbial influence Pathophysiology:
- The disease is characterized by a dominant Type 1 (Th1) cell mediated cytotoxic immune ressponse against epithelial antigens
Prevalence
- worldwide prevalence of approximately 2.2%
- more frequently seen in women than man
- 30 - 60 years of age
Histological Features
Clinical Features
Location
- buccal mucous membranes, particularly posteriorly are by far the most frequently affected site
- Gingiva is often affected
Appearance
- Lesions are bilateral and symmetrical
Various Patterns:
- Reticular comprises a meshwork pattern of find white lines caused by keratinsiation (striae)
- Atrophic - produces red areas of epithelial thinning, oftne ocmbined with striae
- ulcerated/erosive - shallow irregular ulcers covered by smooth, slihglty raised yellowish layer of fibrin
- Plaque - like : often indistinguishable from other leukoplakias
- Bullus - small blisters that can produce ulcers
- Papular - characterized by small raised papules
Differential Diagnoses
- Lichenoid drug reactions
- contact lichenoid reactions
- Chronic ulcerative stomatitis
- Linear IgA disease
- Mucous membrane pemphigoid
- Pemphigus vulgaris
- Lupus Erythematosus
- Graft vs host disease
Relevant Clinical Investigations
- biopsy
- Anti-nuclear antibody test (SLE)
- DIF to distinguish from vesiculobullous disordres
- if ulcerated :
- Full blood count
- Iron, ferrition, B12, folate