Vesiculobullous Disease Flashcards
Name 3 common vesiculobullous diseases?
Mucous membrane pemphigoid
Pemphigus vulgaris
Erythema multiforme
Who does mucous membrane pemphigoid affect?
Autoimmune process affecting 50-60 yo
1:2 male to female ratio
What are the clinical features of MMP?
Oral vesicles/blisters
Desquamative gingivitis appearance
Ocular lesions called conjunctival scarring
Anogenital lesions
Skin lesions (scalp)
Nasal mucosa
How is MMP diagnosed?
Clinical findings
Histological and immuopathological findings
Biopsy - H+E staining from affected tissue, direct immunofluorescence microscopy (DIF) - from perilesional tissue
Indirect immunofluorescence - blood sample
Who is affected by pemphigus vulgaris?
Autoimmune process affecting more females than males
What are the clinical features of PV?
Blisters, erosions and ulcers
Oral bullae which quickly rupture to leave erosions/ulcers
Desquamative gingivitis appearance
Ocular involvement
Aerodigestive tract
Anogenital bleeding
Skin lesions
Very painful
Systemically unwell, potentially lethal
How is PV diagnosed?
Clinical, histological and immunopathological findings
Nikolsky’s sign (rubbing the mucosa induces a bulla)
Biopsy - H+E staining from affected tissue and DIF from perilesional tissue
Indirect immunofluorescence - blood sample, more sensitive in PV than in MMP
How are vesiculobullous diseases managed?
Provide symptomatic relief and refer to OM
Betamethasone mouthwash
Difflam
If eye involvement, consider liaising with GP
Management in OM - liaise and investigate with biopsy, blood tests and long-term treatment
What is the systemic tx for vesiculobullous diseases?
Prednisolone
Dapsone
Doxycycline
Azathioprine
Mycophenolate
Methotrexate
Rituximab
IV immunoglobulins
Describe erythema multiforme
Acute onset
Hypersensitivity reaction - often has a trigger
Ulceration and blistering of oral mucosa and lips
Skin rash
10-40 years old
Recurrence up to 25%
What is the aetiology of EM?
Hypersensitivity
Infective - HSV-1 in some cases
Drugs - allopurinol, carbamazepine, NSAIDs, phenytoin
Following TB or Hep B immunisations
How is EM managed?
Refer to OM for advice
Topical steroids for oral lesions (minor EM)
Systemic steroids for more severe disease
Adjunctive oral care (hygiene, CHX, comfort measures)
Antihistamines for skin itch
Stop any obvious precipitating medication
Consider inpatient admission
How is recurrent EM managed?
Consideration of inmunosupression
Prophylactic aciclovir - due to HSV implication
