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BDS4- Oral medicine PreReading > Vesiculobullous and Immune Disease > Flashcards

Vesiculobullous and Immune Disease Flashcards

1
Q

What immunological oral diseases are there

A

Local diseases
-Aphthous ulcers
-Lichen planus
-OFG

Systemic disease with local effects
-Erythema Multiforme
-Pemphigus
-Pemphigoid
-Lupus erythematosis
-Systemic Sclerosis
-Sjogren’s Syndrome

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2
Q

What type of immune mediated disease is Erythema multiforme

A

Hypersensitivity type 3

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3
Q

What type of immune mediated disease is pemphigus and pemphigoid

A

Antibody mediated immunity, type 3

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4
Q

Why does immunulogical skin disease affect skin and oral/genital mucosa

A

share many common antigens and epitopes

many blistering skin conditions also affect the mouth

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5
Q

How does immunological skin disease happen

A

Auto-antibody attack on skin components causing loss of cell-cell adhesion

‘Split’ forms in skin
-Fills with inflammatory exudate
-Forms vesicle/blister

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6
Q

What is the best test for a immunological skin disease

A

Immunoflorescence

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7
Q

What is immunofloresence

A

technique for determining the location of an antigen/antibody in tissues by reaction with an antibody/antigen labelled with a fluorescent dye

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8
Q

What are the 2 types of immnufloresence

A

Direct and Indirect

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9
Q

Whats the difference with direct and indirect immunofloresence

A

Direct targets antibody bound to the tissue

Indirect detects antibody CIRCULATING not yet bound to the body. Detected from a plasma sample

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10
Q

What is erythema multiforme

A

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

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11
Q

How does erythema multiforme appear

A

On the skin as target lesions

On the mucosa as ulcers

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12
Q

What is the treatment for erythema multiforme

A

High dose prednisalone to suppres the antibody antigen reaction

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13
Q

Whats the main problem that can arrise from erythema multiforme

A

Dehydration as it is too painful to swallow anything or eat

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14
Q

What is the treatment for oral lesions of erythema multiforme

A

Systemic steroids-up to 60mg/day

Systemic aciclovir

Encourage fluid intake and analgesia

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15
Q

If there is recurrent problems with erythema multiforme what is thetreatment

A

prophylatic acoclovir 400mg twice daily

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16
Q

What is angina bullosa haemorrhagica

A

The most common oral blistering condition

blood blisters in the mouth that are rapid onset and last about an hour before bursting

17
Q

What is the most common site for angina bullosa haemorrhagica

A

Buccal mucosa and soft palate

18
Q

What is pemphigoid

A

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

19
Q

What does pemphigoid look like

A

Thick walled blisters that are clear or blood filled

20
Q

What are the different forms and presentations of pemphigoid

A

Bullous Pemphigoid - skin

Mucous Membrane Pemphigoid – all mucous membranes (eye, genital, oral)

Cicatritial Pemphigoid – mucosal with scarring

21
Q

What is the histopathology of pemphigoid

A

sub-epithelial split and hemi-desmosomes involved at the basement membrane

22
Q

In a immunoflorescence test of pemphigoid what does the test look like and what antibodies are found

A

Linear staining along the basement membrane

C3 and IgG and IgA occasionally found

23
Q

What does pemphigoid cause

A

Bullous lesions on the skin

Mucous membrane lesions on the eye/nouth/genitals

Scarring may occur (Cicatritial Pemphigoid)

24
Q

How do you manage pemphigoid

A

With immunosuppresants

Steroids

Immune modulating Drugs – azathioprine, mycophenolate

25
Q

What is pemphigus

A

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

26
Q

What does pemphigus cause

A

intraepithelial bullae

27
Q

What is the histopathology of pemphigus

A

Loss of epithelium and shedding of the epithelial layer that is supra-basal

Tzank cells are also found

28
Q

What would an immunoflurescence test showin pemphigis

A

Basket weave pattern looking

C3 and IgG antibodies

29
Q

What do you rarely see in pemphigus

A

intact bullae

BDS4- Oral medicine PreReading (11 decks)

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