Vesiculobullous and Immune Disease Flashcards
What immunological oral diseases are there
Local diseases
-Aphthous ulcers
-Lichen planus
-OFG
Systemic disease with local effects
-Erythema Multiforme
-Pemphigus
-Pemphigoid
-Lupus erythematosis
-Systemic Sclerosis
-Sjogren’s Syndrome
What type of immune mediated disease is Erythema multiforme
Hypersensitivity type 3
What type of immune mediated disease is pemphigus and pemphigoid
Antibody mediated immunity, type 3
Why does immunulogical skin disease affect skin and oral/genital mucosa
share many common antigens and epitopes
many blistering skin conditions also affect the mouth
How does immunological skin disease happen
Auto-antibody attack on skin components causing loss of cell-cell adhesion
‘Split’ forms in skin
-Fills with inflammatory exudate
-Forms vesicle/blister
What is the best test for a immunological skin disease
Immunoflorescence
What is immunofloresence
technique for determining the location of an antigen/antibody in tissues by reaction with an antibody/antigen labelled with a fluorescent dye
What are the 2 types of immnufloresence
Direct and Indirect
Whats the difference with direct and indirect immunofloresence
Direct targets antibody bound to the tissue
Indirect detects antibody CIRCULATING not yet bound to the body. Detected from a plasma sample
What is erythema multiforme
Spectrum disorder of Immunogenic related skin and mucosa ulceration with variable orofacial involvement
Its a spectrum condition sdo it can affects mutiple different places, it can affect any mucosa
Severe multisystem involvement is called Stevens-Johnston syndrome
How does erythema multiforme appear
On the skin as target lesions
On the mucosa as ulcers
What is the treatment for erythema multiforme
High dose prednisalone to suppres the antibody antigen reaction
Whats the main problem that can arrise from erythema multiforme
Dehydration as it is too painful to swallow anything or eat
What is the treatment for oral lesions of erythema multiforme
Systemic steroids-up to 60mg/day
Systemic aciclovir
Encourage fluid intake and analgesia
If there is recurrent problems with erythema multiforme what is thetreatment
prophylatic acoclovir 400mg twice daily
What is angina bullosa haemorrhagica
The most common oral blistering condition
blood blisters in the mouth that are rapid onset and last about an hour before bursting
What is the most common site for angina bullosa haemorrhagica
Buccal mucosa and soft palate
What is pemphigoid
A relatively common immunobollous condition that affects the skin and the mouth and is characterised by sub-epithelial antibody attack
The antibodys causes seperation of the epithelium from the basement membrane from the connective tisse
What does pemphigoid look like
Thick walled blisters that are clear or blood filled
What are the different forms and presentations of pemphigoid
Bullous Pemphigoid - skin
Mucous Membrane Pemphigoid – all mucous membranes (eye, genital, oral)
Cicatritial Pemphigoid – mucosal with scarring
What is the histopathology of pemphigoid
sub-epithelial split and hemi-desmosomes involved at the basement membrane
In a immunoflorescence test of pemphigoid what does the test look like and what antibodies are found
Linear staining along the basement membrane
C3 and IgG and IgA occasionally found
What does pemphigoid cause
Bullous lesions on the skin
Mucous membrane lesions on the eye/nouth/genitals
Scarring may occur (Cicatritial Pemphigoid)
How do you manage pemphigoid
With immunosuppresants
Steroids
Immune modulating Drugs – azathioprine, mycophenolate
What is pemphigus
An immune mediated antobody directed disease that a disease that causes blistering of the skin and the inside of the mouth, nose, throat, eyes, and genitals
What does pemphigus cause
intraepithelial bullae
What is the histopathology of pemphigus
Loss of epithelium and shedding of the epithelial layer that is supra-basal
Tzank cells are also found
What would an immunoflurescence test showin pemphigis
Basket weave pattern looking
C3 and IgG antibodies
What do you rarely see in pemphigus
intact bullae
