Oral Medicine Tutorial 2 Flashcards
what is MMP
a group of autoimmune bullous characterised by subepithelial blisters
who does MMP usually affect
older populations
women more than men
what is the pathogenesis of MMP
autoantibodies are directed against specific adhesion molecules located in hemi-desmosomes of basal membrane
what are intra-oral manifestations of pemphigoid
patchy or generalised gingival sloughing
superficial ulcers and erosions
what is the extra-oral manifestation of pemphigoid
recurring vesicles or bullae affecting mucosa or skin
tends to scar
the blisters break which leave painful ulcers
what is Nikolsky’s sign
formation of new bullae on application of pressure to skin
in which diseases is Nikolsky’s sign present and absent
present in MMP
absent in bullous pemphigoid
what is shown in direct immunofluorescence in MMP
linear deposition of IgG along basement membrane
what is shown in indrect immunofluorescence in MMP
usually negative as serum contains the anti-adhesion antibodies at low titres
what is pemphigus vulgaris
autoimmune blistering disease classified by flaccid blisters
what is the pathogenesis of PV
cutaneous desmoglein-1 is expressed in the whole epidermis (skin lesions only) but desmoglein 3 is found in the lower epidermis (skin and mucosal membrane lesions)
what is the extra oral presentation of PV
flaccid skin blisters which develop to oozing erosions
what is the intra-oral presentation of PV
painful and refractory oral erosions
where is direct immunofluorescence done in PV
in an area of unaffected skin
what is the usual immunosuppressive treatment in MMP
high dose topical corticosteroids
prednisolone
Intravenous immunoglobulin
what is the immunosuppressive treatment in PV
corticosteroids
azathioprine
Rituximab (monoclonal antibody)
what is clobetasol
high dose topical steroid that can help manage desquamative gingivitis but have a candida infection risk
what is the prescribed dose for prednisolone in treating MMP
0.5/1mg per kg per day
what is the prescribed dose for azathioprine for management of MMP
1-2mg per kg per day initially
can be raised to 5mg per kg per day
what is the intravenous immunoglobulin treatment for MMP
400mg per kg per day for 5 days every 4 weeks
what biological therapies are used in MMP
etanercept used in patients who fail to respond to immunosuppressants
what is erythema multiforme
acute immune mediated disorder affecting the skin and mucous membranes
what is EM triggered by
hypersensitivity reactions to various antigens
what is the pathogenesis of EM
when the immune responds to an antigen being targeted by antibody a large complex is formed which cannot pass through capillaries
it gets wedged into tissue and activates complement - perivascular inflammatory response
causes blistering of tissue
give three triggers for EM
herpes simplex virus
NSAIDs
food additives
how does EM present in the mouth
diffuse oral erythema and multi focal superficial ulcerations
how does EM present extra-orally
target lesions on the skin
what would you expect to see in a patient with EM histologically
acanthosis and elongation of rete ridges
what is the treatment options for EM
discontinue any triggers
systemic steroids - 40-60mg prednisolone daily
antiviral - aciclovir 400mg twice daily
immunosuppressive - azathioprine 100-150mg per day
