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Classification:1.Infective:2.Traumatic:3.Idiopathic:RecurrentAphthousStomatitis(RAS)4.Associatedwithsystemicdisease:

Hematological GIT Behcets HIV

5.Associatedwithdermatologicaldiseases: Lichenplanus ChronicdiscoidLE Vesiculobullousdiseases

6.Neoplastic:SCC &others

Mechanical:causes,dxticcriteria,hist

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Chemical:chemicals,aspirinburn

Thermal:palate Factitious:biting,nails

Radiation:immediate&delayed

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Eosinophiliculcer:crushinjurytomuscle

Mostcommon

10-25%

Onset Gender Non-smokers Prodromalsymptoms Diagnosis

Clinicalforms:1.Minoraphthousulcer:

80%

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2.Majoraphthousulcer

2ndmostcommon

1-10butfrequently1-2atanyonetimeDuration:4-6wks/ulcerIntra-oralsitesClinically:depth,size,symptomsHealingRecurrencerate:

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6.Hematologicals:7.GITdisease:8.Allergicdisorders:

Immunological&histologicalfeatures:ImmunemechanismHumoralimmunity?T-cellreaction:Pre-ulcerativestage:SuprabasalepithelialCS,LPLymphoidCsinfiltrateepithInfiltrate&degenerationofepithCsPre-ulcerativestage:CD4:CD8=2:1Ulcerativestage:1:10Healingstage:10:1

Aetiology:?,HLA-B51Youngadultmales

Majorcriteria: MinorcriteriaRAS ArthralgiaGenitalulcers GITlesionsUveitis,conjunctivitis,retinitis ThromboticvascularlesionsE.nodosum,pustular CNSlesions&macularlesions,Subcutaneousthrombophlebitis

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Classification:Intraepithelial:

AcantholyticPemphigusDariersdisease(Follicularkeratosis)Non-acantholyticViralinfections

Subepithelial:Erythemamultiforme LinearIGAdiseasePemphigoid BullouslichenplanusDermatitisherpitiformis OralbloodblistersEpidermolysisbullosa

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Pathogenesis:AutoimmunediseaseIGgtodesmosomes(desmogleinIII)Skin&MMsDIF&IDIF:fishnetpattern

Hist:MildinflammationinLPCleft-likespacesjustabovebasalcelllayerTombstonesTzanckcells

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Clinically:UncommonF,40-60,Mediterranean

Orallesions:50%initialsite,ultimatelyinvolvedinallcasesConfinedtooralcavityinsomeptsSoftpalateFragilebullous painfulerythematoussuperficialerosionswraggededgesSitesoftrauma:larger&moresymptomaticlesionsNikolskyssignFatal

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Othersites:nasopharynx,esophagus,vaginacanbeinvolvedOtherforms:Foliaceous,Vegetans

Clinically:Youngadults,M>FAbruptonsetProdromalphaseWiderangeofclinicalmanifestationsMildforms:oralskinorskinaloneSkinlesion:variable,targetoririslesion,hands&feetOrallesions:-Esp.onlipsandantmouth,erythematousvesiculobullouseruptionserosions-Circumoralcrusting

Stevens-Johnsonsyndrome:widespreadinvolvement10-14daysRecurrences

Pathogenesis:

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Unknown,spontaneousPrecipitatingfactors:sulphonamides,HSTypeII Ihypersensitivityrxn:-Depositionofimmunecomplexes(IgM&C3)insuperficialvesselsischemiaofepithDx:clinical,immunologicalfindingsarenegativeornonspecificHist:nonspecific,intraepithelial/subepithelialbullae,necroticlid,CICIinLP

Pathogenesis:AutoimmunediseaseLineardepositsofIGg&C3inBMzone

Hist:SubepithelialbullaeStartsasfocaledemaatBMwnoinflammationinLPSeparationoffullthicknessofepithelium(LaminaLucida)Neutrophils&eosinophilsin&aroundbulla,perivascularinflammationinLP

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Clinically:Elderly,F>MSeverityTwotypes:BullousPemphigoid:Skin10-20%orallesions+DIF,+IDIFin75%ofcases

MucousmembranePemphigoid:Skin:uncommon&minimalOralmucosa:

AlmostalwaysaffectedUsuallyprecedeothersitesInsomecasestheonlylesionsBullae:tense,tough(remainfewdays),bloodblisters

Erythematousareas,well-definedmargins,fewwksSlowlyhealscarring(CicatricialPemphigoid)Anywhere,desquamativegingivitisNasopharynx,larynx&esophagus

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GenitallesionsConjunctiva:bullae,erosions scarringwadhesions(symblepharon)+DIF&80%+IDIF

Rareskindisorder Itchyrashoftenovershoulders Glutensensitivity

Orallesions

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70%ofcasesErythematous,purpuric,vesicularorulcerativePalate,BM,Gingiva

Hist:MicroabscessesattipsofCTpapillaeDIF:granulardepositsofIgA&C3attipsofCTpapillae

Rare SimilartoDHbutglutensensitivity DIF :LineardepositsofIgAalongBMzone Lymphoma

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SeparationoftheepitheliumfromunderlyingCT Largeblisters extensive&oftenimmobilizingscarformation Threehereditaryforms&oneacquiredform

EB simplex: Intraepithelialbullae AD Appearsduringinfancy&improvingbypuberty Mild Sitesoffrictionortrauma Mildintraoralblisters Teethnotaffected

Junctional(gravis): AR Severeform SeparationwithinlaminaLucida Hgiclargebullaeinvolvingface,trunk&extremities,lossofnails&scarring Extensiveinvolvementofallmucosae Severehypoplasiaofteeth

Dermolytic(dystrophic)form: AD Separationbeneaththebasallamina Lesionsapparentatbirth Sitesofpressure bullae deepscars contracture

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Trismus,Ankyloglossia,obliterationofsulci Delayederuption&hypoplasiaofteeth

EB acquisita: Autoimmune:IgG&C3totypeVIIcollagenofanchoringfibers Adulthood Dermolytictype DIF:Linear,BM

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(Anginabullosahaemorrhagica,localizedoralpurpura) Spontaneousblood-filledbullae Subepithelial2-3cmin ulcer Palate Chocking Aetiology?