Immunologically mediated disease Flashcards
Immunological oral disease:
- Local
- Systemic disease: oral effects
- Local - Apthous ulcers/lichen planus/OFG/Lupus erythematous
- Systemic - Pemphigus vulgaris/Pemphigoid/erythema multiforme/Lupus erythematous/systemic sclerosis/sjogren’s syndrome
Types of recurrent apthous stomatitis
Minor
Major
Herpetiform
Behcet’s
Features of minor apthae
<10mm Shape - round/oval with red halo/yellow base No. - 1-20 Affects - NON KERATINISING mucosa Duration - 1-2 weeks Outcome - no scarring
Features of major apthae
>10mm Shape - irregular/oval No. - <5 Affects - KERATINISING NON KERATINISING mucosa Duration - 6-12wks Outcome - scarring
Features of Herpetiform apthae
<5mm Shape - round/oval, coalesce No. - 1-200 Affect - NON KERATINISING mucosa Duration - 1-2wks Outcome - no scarring
Features of Behcet’s sydrome
Oral ulceration Genital ulceration Neurological - motor/sensory disturbance Eye disease - blindness Arthritis
Aetiology of recurrent apthae
- Autoimmune - CD4 cells attack epithelial cells
- Trauma
- Systemic disease- Coeliac/Crohns/UC/Pernicious anaemia
- Stress - hormonal imbalance
- Allergy - benzoates/cinamonaldehyde/sorbic acid
- Genetic
- Nutritional deficies - folate, iron, B12
Treatment of ulceration
Medication
Correct deficiency
Correct trauma source
Correct systemic disease
Remove allergens
Medication:
Salt mouthwash
Topical lidocaine oitment 5%
CHX 0.2% 10ml 2x daily
Topical corticosteroids
Betamethasone tablets - 2 tablets/2ml/2mins/2x daily
Beclometasone Inh 2 puffs 2x daily
Systemic steroids
Azathioprine
Lichen Planus features.
Types
Skin - itchy papules, mucosa - white patches
Types:
Reticular/Plaque/Papular/erosive/atrophic/bullous/
desquamative gingivitis
Lichen Planus - aetiology
Autoimmune Idiopathic Drugs - B blockers Amalgam SLS Poor OH
Pathogenesis of Lichen Planus
Autoimmune - CD4/CD8 cells infiltrate Loss of intercellular attachment (acantholysis) Apoptosis Atrophy Keratinisation/Hyperplasia Hugging band of lymphocytesLic
Lichenoid reaction causing drugs
NSAID/Antihypersensitives/Hypoglycaemics/Diuretics
Lichen Planus treatment - asymp and symp
Asymptomatic: OH
CHX 0.2% Mw
Symptomatic:
Topical corticosteroids - betamethasone/beclometasone
SLS allergy - avoidance
Immunodulation - azathioprine
Erythema multiforme - aetiology, sites
Aetiology:
Immune complex - HSV/hypersensitivity
Sites - lips/anterior of mouth - Crusting, brown area of lips, Skin - target (bullseye) lesions
Erythema multiforme - treatment
-Oral lesions - Systemic steroids Prednisolone 60mg
Systemic aciclovir
- Encourage fluids
- Encourage analgesia
Erythema Multiforme - Histological features
Intracellular oedema, necrosis - INTRAEPITHELIAL VESCICLES
Inflammation
Vesiculobullous conditions
Pemphigus Vulgaris, Pemphigoid, Angina Bullosa Haemorrhagica, Epidermolysis Bullosa
Immunofluorescence principles
Anti IgG + Fluorescent particles, attaches to IgG
Pemphigoid features
Clinical
Histology
Immunofluorescence pattern
-SUBEPITHELIAL VESCICLE (Antibody attack)
Thick walled blisters
Blister seen intraorally - sometimes blood filled
Immunofluorescence - Fluorescent line (basal cell layer separate from epithelium)
HEMIDESMOSOMES
Oral/skin lesions - scarring
EYE lesion - blindness
Pemphigoid Treatment
Systemic steroids/immunosuppressants - azathioprine/steroids
Pemphigus Vulgaris
Features
Histology
Immunofluorescence pattern
Pemphigus Vulgaris - skin and mucosa
INTRAEPITHELIAL BULLAE, DESMOSOMES AFFECTED
Ashkenazi Jews
Blisters - not often seen as they burst easily, clear fluid
Deadly disease if not treated
Histology - intraepithelial bullae(suprabasal split) - Acantholytic cells (tzanck cells)
Immunofluorence pattern - Basket weave
Angina bullosa haemorrghica
Features
Cause
Inv
Blood blisters in abscence of trauma
Steroid inhaler
Affect palate - advise patient to deroof
Inv - PLT count, coagulation screen, LFT, blood glucose
Management of Desquamative gingivitis
Change toothpaste - SLS allergy Improve OH Topical steroids - Betametasone/Beclomethasone Topical Tacrolimus Systemic immunosuppresion
