Oral Med Revision - Vesiculobullous Disease

Question 1

mucous membrane pemphigoid

Answer 1

autoimmune process
50-60yrs
1:2 M:F
clinical features -> oral vesicles/blisters that become ulcers, desquamative gingivitis, ocular lesions can lead to conjunctival scarring, anogenital lesions, skin lesions on scalp, nasal mucosa

Question 2

diagnosis of MMP

Answer 2

clinical / histological / immunological
1. biospy
- H&E staining from affected tissue
- direct immunofluorescence microscopy from perilesional tissue

2. indirect immunofluorescence - blood sample

Question 3

pemphigus vulgaris

Answer 3

autoimmune
F>M
clinical - oral bullae which quickly rupture to leave erosions/ulcers; often 1st clinical feature, desquamative gingivitis, ocular involvement, aerodigestive tract, anogential blistering, skin, +++ pain, potentially lethal, systemically unwell; impaired oral intake, sepsis (2ndary bacterial/fungal/viral infection)

Question 4

dx of PV

Answer 4

clinical / histological / immuopathological
1. nikolsky’s sign - rubbing mucosa induces a bulla
2. biopsy
- H&E staining from affected tissue
- direct immunofluorescence from perilesional tissue
3. indirect immunofluorescence - blood sample; more sensitive in PV than MMP

Question 5

mx of vesiculobullous dx

Answer 5

provide symptomatic relief & refer to OM
- betamethasone MW
- difflam
if eye involvement liaise with pt GP
mx in OM inc biopsy, blood tests & long term tx
systemic tx = prednisolone (pulsed), dapsone, doxycycline, azathioprine, methotrexate

Question 6

erythema multiforme

Answer 6

acute onset
hypersensitivity reaction; often identify trigger
ulceration & blistering of oral mucosa & lips
skin rash
younger cohort (10-40yrs)
minor or major
recurrence up to 25%

Question 7

EM aetiology

Answer 7

hypersensitivity
infective - HSV in 15-20%
drugs - allopurinol, carbamazepine, NSAID, phenytoin
following BCG / hep B immunisations

Question 8

EM mx

Answer 8

refer to OM
- topical steroid for oral lesions in minor EM
- systemic steroids for more severe dx
- adjunctive OHI
- antihistamines for skin itch
- stop any obvious precipitating medication
- consider admission

recurrent EM = consider immunosuppression i.e. AZA / MMF or prophylactic aciclovir (due to HSV implication)