Blistering ulcerative conditions

Question 1

information on vesiculobullous diseases and its types

Answer 1

• immune mediated disease
• 4 types - pemphigoid/gus, erythema multiforme and angina bullous haemorrhagica

Question 2

What causes the immunogenic reaction for each of the following :
- erythema multiforme
- pemphigoid/gus
- aphtous stomatitis
- OFG
- lichen planus

Answer 2

• type 3 hypersensitivity = erythema multiforme
• antibody = pemphigoid/gus
• cell mediated = OFG , lichen planus and aphthous ulceration

Question 3

in antibody mediated ulcerative conditions (what are these) what is the chemical mechinism for their cause

Answer 3

• antibody has affinity for a protein, specifically a certain epitope on that protein.
• this changes the shape of the protein and thus is function / appearance = link to the clinical appearance
• embryologically skin and mucosa from similar area thus share similar diseases with this cause

Question 4

what attaches cells together within the epithelium and to the lamina propria

what is the protein in this called that is atacked by antibody related ulcerative conditions

Answer 4

• desmosomes cell to cell in epithelium
• hemidesmosomes cell - lamina propria cells
• desmoglien

Question 5

what is test for pemphigoid/gus

Answer 5

• direct / indirect immunofluorescence
• direct = biopsy (already bound to tissue) - more for diagnosis
• indirect = from PLASMA of blood (not bound yet) - more for disease activity levels

note - biopsy cannot be placed in formalin transport medium as lose binding sights

Question 6

what is erythema multiforme
- mode of action
- causes of this reaction
- where effects
- another name for this
- oral symptoms
- tell tale sign of this condition

Answer 6

• type 3 hypersensitivity reaction (to herpes simplex, drugs or bacteria - mycoplasma)
• antibodies from b cells bind with a previously known antigen (most likely) combining within the circulaiton, get stuck in capillaries as cant fit through = complements activated in blood vessels = vascular inflammatory response
• systemic condition - can be skin, genital, mucosal (oral, pharygeal etc.)x
• target type lesions on skin and ulcers on mucosa (lesion, band of paleness perilesionally then erythematous tissue surrounding)
• another name = steven johnston syndrome
• agony = cannot eat or drink
• MORE present at front of mouth - crusting lips from ulcer healing = E.M.MUST BE IN DIFFERENTIAL DIAGNOSIS

Question 7

treatment for ORAL LESIONS in erythema multiforme

Answer 7

1. systemic steroids (up to highest doses - 60mg/day) - prednisolone (stops antibodys binding and complement activation in tissue
2. systemic aciclovir
3. encourage fluid intake and analgesics
4. recurrent = aciclovir prophylaxis daily and allergy test as wide range of env. triggers

Question 8

information on angina bullosa haemorrhagica
- cause
- symptoms
- treatment
- where effected
- healing?
- worst lesions and contents of blister

Answer 8

• blood blistering condition
• cause = minor trauma / unknown
• generally no symptoms
• where = buccal mucosa (tramua caused) and soft palate (unknown cause)
• tx = symptom tailored - difflam spray and chlorhexidine mouthwash
• healing = in a few days but can be recurrent
• can get larger lesions at junction between hard and soft palate but mostly blood stained inflammatory exudate rather than blood)

Question 9

… pemphigoid and gus information…

Answer 9

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