16 - Vesiculobullous and immune disease

Question 1

What are the types of immune mediated disease?

Answer 1

• hypersensitivity (type 1, 2, 3, 4 or 5)
• immunogenic (cell or antibody mediated)

Question 2

Name local immunological oral diseases.

Answer 2

• aphthous ulcers
• lichen planus
• orofacial granulomatosis

Question 3

Name systemic immunological diseases that have local oral effects.

Answer 3

• erythema multiforme
• pemphigus
• pemphigoid
• lupus erythematosis
• systemic sclerosis
• Sjögren’s syndrome

Question 4

What type of immune mediated disease is erythema multiforme?

Answer 4

Hypersensitivity type 3

Question 5

What type of immune mediated disease are aphthous ulcers?

Answer 5

Cell mediated immunity

Question 6

What type of immune mediated disease is lichen planus?

Answer 6

Cell mediated immunity

Question 7

What type of immune mediated disease is orofacial granulomatosis?

Answer 7

Cell mediated immunity

Question 8

What type of immune mediated disease is pemphigus?

Answer 8

Antibody mediated immunity

Question 9

What type of immune mediated disease is pemphigoid?

Answer 9

Antibody mediated immunity

Question 10

How do immunological skin conditions present?

Answer 10

• auto-antibody attack on skin causes loss of cell-cell adhesion
• this forms a split in the skin
• fills with inflammatory exudate
• this is the blister or vesicle

Question 11

What protein is the target of immunological skin conditions?

Answer 11

Desmoglein (forms the desmosome attachment between cells)

Question 12

How is immunoflorescence used in the monitoring and diagnosis of immune diseases?

Answer 12

• direct immunoflorescence is used to visualise antibody mediated disease when the antibody is bound to tissue
• indirect immunoflorescence is used to monitor disease activity by a plasma sample of antibody that has not yet bound to tissue

Question 13

What is erythema multiforme?

Answer 13

• spectrum disorder of immunological related skin and mucosa ulceration
• orofacial involvement is variable
• hypersensitivity type 3 reaction

Question 14

What areas of the body are typically involved in erythema multiforme?

Answer 14

• lips and anterior mouth
• skin
• conjunctiva
• nose
• pharynx
• genitals

Question 15

How does erythema multiforme present?

Answer 15

• triggered by an antigen that has been seen before, immune response combines and clogs capillaries which activates complement
• inflammatory lesions present with crusty lips and ulceration of the mucosa

Question 16

What is the management of oral erythema multiforme?

Answer 16

• encourage fluids
• encourage analgesia
• systemic high dose steroids (prednisolone)
• 2y - systemic acyclovir

Question 17

What is angina bullosa haemorrhagica?

Answer 17

• most common oral blistering condition
• blood blisters form in the mouth for around 1 hour then burst
• painless
• can be caused by minor trauma
• heal with no scar within days

Question 18

Where is it common for angina bullosa haemorrhagica to occur?

Answer 18

• buccal mucosa
• soft palate (at vibrating line)

Question 19

What is the management of angina bullosa haemorrhagica?

Answer 19

• chlorhexidine mouthwash
• reassurance that disease is benign
• explore triggers