Vesiculobullous Diseases Flashcards
Antibody mediated diesease
pemhigoid
pemphigus
Cell mediated diseases
lichen planus
ulcers
orofacial granulomatosis
Immunological skin diseaes
Auto antibody attack on skin components causing a split to form on the skin which inflammatory exudate can pass and force apart different layers of skin which form blisters/ulcers
Components they attack could be hemidesomomes or desomosome
What are desomosomes
they produce cell to cell adhesion so if affected its lost causing an intraepithelial blister found in pemiphigus
What specific protein is attacked
desmoglein
Direct immunofluroscent
biopsy is taken from a non ulcerated site and fluroscent antibody attached
if does not attach then blistering disease present
Indirect immunofluroscent
tests for circulating antibodies
Used cells from animals
Erythema multiforme
pt gets blistering or ulcers
lasts for 2-3weeks
What is extreme form of eryhtema multiforme
Steven Johnson’s syndrome
Tx for erythema multiforme
High dose prednisolone to suppress antiobdy antigen reaction
analgesia
keep hydration high
If recurrent - prophlactic aciclovir daily (400mg x 2 daily), allergy test
What type of lesions can present on skin with erythema multiforme
target lesions
Angina bullosa haemorragica
oral blood blisters that occur in soft palate or buccal mucosa
lasts about 1 hour then burts to form small ulcers
Heal with no scarring
x for angina bullosa haemorragica
reassure benign
chx mw or difflam
What is pemphigoid
when the antiobdy attack the subepithelial
it causes sepration of the epithelium from the basement membrane and the full thickenss of the epithelium is released with inflammatory exudate filling space between epidermis and connnective tissues
It causes hemidesomomes to sop adehering
What are the 3 types of pemphigoid
Bullous pemphiod ( skin)
Mucous membrane pemphigoid
Cicatrical pemphigoid - mucosal without scarring
Immunofluresence of pemphigoid show
A linear staining along basement memebrane
IgG and C3 detected
Occasionally IgA can also be detected
Tx for pemphogoid
Steriods - prednisolone
Immunosuppresants - azathrioprine, mycopheriolate
Why no tzank cells present in pemphigoid
due to no weaking of the attachement (acantholysis) in this disease
Nature of pemphigoid disease
autoimmunie disease in which igG antibodies are formed against consitituents in basement membrane area and hemidesomsomes
How does pemhigus differ from pemhigoid
as it causes intraepithelial bullae due to the desmomes being affected
Hypersenstivity type
Type II - where IgG antibodies are produced
Pemphigus vulcaris
where mucosa is first site to be affected
Tzank cells present in cleft
found in pemhigus, often round as no cells to keep them normal shape
Immunofluorsence for pemphigus
Basket weave apppearance
