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Keeling Spring Textbook > 1. Desquamative Gingivitis > Flashcards

1. Desquamative Gingivitis Flashcards

1
Q

What is desquamative gingivitis

A

A clinical term for red/ ulcerated gingiva

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2
Q

What are the types of immunoflouresence, and how do they differ

A

Direct and indirect. Direct is applied directly to the tissue, indirect utilizes an animal serum for example monkey

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3
Q

How do you fix biopsy samples

A

Formalin 10% for H and E, Michels 7% for immuno

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4
Q

What is OLP

A

Inflammatory muco cutaneous disease of mucosal surfaces

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5
Q

Who gets OLP

A

2:1 F:M, middle aged women

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6
Q

What are the types of OLP

A

Reticluar, erosive and vesicular

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7
Q

Where is OLP commonly located

A

Lateral Tongue, Buccal Mucosa, Gingiva, Palate

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8
Q

What is pathology of OLP

What infiltrates where

A

Sub epithelial infiltration of T Cells,

Basal cell liquefaction, saw tooth rete pegs, Civatte bodies

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9
Q

What is the immunoflouoresence of OLP

A

C3 and IgM

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10
Q

What is the malignant potential of OLP

A

2%

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11
Q

What is the treatment of OLP

A

Oral rinse: Lidex

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12
Q

How do you take a biopsy

A

Normal and abnormal tissue. Abnormal tissue will show disease, but normal tissue will also show the disease in Pemphigus and Pemphigoid

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13
Q

What is Pemphigoid

A

Immune mediated sub epithelial bullae

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14
Q

Who develops Pemphigoid

A

Its uncommon, Ladies over 50

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15
Q

What are the subtypes of Pemphigoid

A

Bullous, Mucous Membrane, Citatricial

Black Minesweepers Meditated Cockily

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16
Q

Which type of Pemphigoid affects the eyes and genitals

A

Mucous Membrane

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17
Q

Where does Pemphgoid occur intra orally

A

Gingiva or soft palate

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18
Q

What is the clinical appearance of Pemphigoid

A

Tense Bullae or Desquam gingivitis. Bullae last several days.

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19
Q

What is the pathologic appearance of Pemphigoid - What do you see down the mircoscope… Don’t forget immunoflouoresence…

A

Sub epithelial vesicles, linear IgG and C3 at basemenr membrane

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20
Q

What is the positive rate of immunoflouoresence in Pemphigoid

A

90% positive

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21
Q

What is the treatment for Pemphigoid

There are 3…

A

Lidex, Clobetasol 0.5%, or biologics if refractory

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22
Q

What is pemphigus

A

An autoimmune bullous disorder

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23
Q

Who gets pemphigus

A

M=F, 40 - 60 yo, Ethnic Groups

Serious
Both of us

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24
Q

What are the 4 subtypes of pemphigus

A

Vulgaris, foliaceous, vegitans and paraneoplastic

Victor flogged velvet Perseus

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25
Q

What is the clinical presentation of pemphigus

What sign is clinically important

A

Rarely see bullae, usually ulcers/ blisters, large and painful. Positive Nikolsky sign

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26
Q

What is the pathology of pemphigus

What do you see down the microscope

A

Intra epithelial bullae
Acantholysis
Tzanck Cells

27
Q

What is the immunoflouresence of pemphigus

You know this…

A

Chicken Wire appearance, IgG and C3

28
Q

What is the trt of pemphigus

A

Systemic steroids..

Prednisolone 150-360 mg daily for 6-8/52

29
Q

What is chronic ulcerative stomatitis

A

Chronic ulcerative stomatitis (CUS) is an immune‐mediated disorder characterized by oral erosions and ulcers usually refractory to conventional treatments.

The disease often involves middle‐aged and older women with painful lesions.

Sometimes resembling those of erosive oral lichen planus.

30
Q

Who gets chronic ulcerative stomatitis

A

Women in their 40’s

31
Q

What are the clinical signs of chronic ulcerative stomatitis

what do you see when you look in their mouth

A

Small blisters and erosions

32
Q

Where are the lesions of chronic ulcerative stomatitis found

A

Gingiva and lateral border of the tongue

33
Q

What is the pathology of chronic ulcerative stomatitis

What do you see down the microscope

A

hyperkeratosis, acantholysis, liquefaction of basal cell layer

34
Q

What is the immunoflouoresence of chronic ulcerative stomatitis

It is speckled

A

Speckled IgG

35
Q

What is the treatment of chronic ulcerative stomatitis

A

Mild- topical steroids

36
Q

What is Linear IgA Disease

A

An uncommon muco cutaneous disease

37
Q

Who develops Linear IgA Disease

A

Middle aged ppl

38
Q

What are the clinical signs of Linear IgA Disease

Its a real mouthful

A

Pruritic vesiculo bullous rash, plaques annular manifestation

39
Q

Where does Linear IgA Disease occur

A

Anywhere on the body

Scars Mucous membranes

40
Q

What is the pathology of Linear IgA Disease

A

Subepidermal blisters with neutrophilic infiltration

Identical to dermatitis herpetisformis

Immune mediated maybe

41
Q

What is the immunofluoresence of Linear IgA Disease

A

IgA - duh

42
Q

What is the treatment of Linear IgA Disease

A

Sulfones and Dapsone.

IgA - d A psone

43
Q

What is dermatitis herpetiformis

A

Dermatitis herpetiformis (DH) is a rare, chronic, autoimmune skin condition, seen in young adults.

It is characterized by the presence of groups of severely itchy blisters and raised red skin lesions.

These are most commonly located on the elbows, knees, buttocks, lower back and scalp.

44
Q

What systemic autoimmune disease is associated with Dermatitis Herpetiformis

A

Celiac Disease - 25% of pts have this

45
Q

What are the clinical symptoms of Dermatitis Herpetiformis

A

Bilateral symmetrical pruritic papules, extensor surfaces of extremities, cluster vesicles

46
Q

What is the pathology of Dermatitis Herpetiformis

A

Focal aggregation of neutrophils, fibrin deposits at dermal pegs

47
Q

What is the immunofluoresence of Dermatitis Herpetiformis

A

IgG and C3

48
Q

What is the treatment for Dermatitis Herpetiformis

A

Gluten free diet, dapsone

49
Q

What is Lupus

A

An autoimmune disease

50
Q

What are the signs of lupus extra orally

A

Malar butterfly rash

51
Q

What are the intra oral signs of Lupus

A

Hyperkeratotic Plaque

52
Q

What is the pathology of Lupus

What do you see down the microscope

A

Anti Nuclear Antibodies.

C3 at dermal/ epidermal junction.

53
Q

What is the treatment of Lupus

A

Topical steroids, systemic steroids

54
Q

What is Erythema Multiforme

A

Immune complex vasculitis.

Classified as Minor or Major.

Acute bullous and macular inflammatory muco cutaneous disease.

55
Q

Who develops Erythema Multiforme

A

20 - 40 year old. Frequently associated with drugs

56
Q

What is associated with development of Erythema Multiforme

A

Herpes and Drugs.. A lot of drugs!

57
Q

What are the clinical signs of Erythema Multiforme

A

Multiple large painful ulcers

70% of pts have oral lesions.

Target Lesions.

58
Q

What is the pathology of Erythema Multiforme

A

Liquefaction of the upper epithelium

Intra epithelial microvesicles

No acantholysis

59
Q

What is the immunofluoresence of Erythema Multiforme

Think about it - Or maybe don’t!!

A

None

60
Q

What is the treatment of Erythema Multiforme

A

Topical anti histamines, topical anaesthetics

61
Q

How do you assess for drug related reactions

What filling materials may be implicated

A

Multi form.

Contact allergy.

Biopsy and patch test.

Replace amalgam.

62
Q

What are the key issues to know according to Dr Villareal

A

OLP, Pemphigus, Pemphgoid. Table 26.1 about the immunof of everything and what the immunof looks like

63
Q

What are the differences between apthous ulcers and herpetic lesions

A

Apthous: Movable mucosa, do not coalesce

Herpetiform: Bound keratinized tissue, coalesce

64
Q

How do you treat herpetic lesions

A

5% acyclovir

Lesions self limiting, last 7 - 14 days.

Keeling Spring Textbook (7 decks)

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