Vesiculobullous Diseases Flashcards
What are the cell mediated immunity Vesiculobullous diseases?
Aphthous ulcers
Lichen planus
Orofacial granulomatosis
What are the antibody mediated immunity Vesiculobullous diseases?
Pemphigus
Pemphigoid
What is Erythema Multiforme?
A spectrum disorder of immunogenic related skin and mucosa ulceration
Type 3 hypersensitivity (it is an immune mediated disease)
How does Erythema Multiforme occur?
An antigen presents which is targeted by an antibody, usually one that the body has met before which prompts an immune response through regenerating memory B cells. These antigens and antibodies combine in the circulation and this large complex is not unable to pass through capillaries. So when this complex reaches the tissues it becomes wedges and activates the complement cascade within blood vessels causing a perivascular inflammatory response. When this is significant the patient will get blistering or ulceration of the tissue
Where it will present depends on the individual antibody and antigen complex and the triggers
What areas can be involved in Erythema Multiforme?
Any area including keratinised areas of the mucosa can be involved
Because the ulceration is happening from within and affects the capillary areas
What is Steven-Johnston syndrome?
Severe multisystem involvement
Affecting the skin, conjuctive, nose, pharynx, mouth and genitals
What is the treatment of a patient who presents early with Erythema Multiforme?
High dose prednisolone
To suppress the antibody antigen reaction and also the complement activation within the tissues
What is the treatment of a patient who presents late with Erythema Multiforme
Must ensure to keep the patients hydration high as most people who end up in hospital admissions due to the mouth and pharynx being too painful for fluid intake leading to dehydration
What is the treatment for Erythema Multiforme?
Urgent medical therapy
–Systemic steroids - prednisolone (corticosteroid)
–Systemic aciclovir (secondary to steroids) antiviral medication
Encourage fluid intake
Encourage analgesia for pain relief
What is the treatment if a patient has recurrent problems of Erythema Multiforme?
Prophylactic aciclovir daily (for herpes simples virus recurrence)
Allergy test- a wide variety of environmental triggers
Sometimes infective agent- mycoplasma
What is Angina Bullosa Haemorrhagica?
Commonest oral blistering condition
‘Blood Blisters’ in the mouth
–buccal mucosa and soft palate most common
–rapid onset appear in a few minutes
–last about 1 hour then burst
Relatively painless
Possibly initiated by a minor trauma
How do Angina Bullosa Haemorrhagica lesions heal?
Mostly heal with no scarring within days
Most of the fluid that comes from these lesions is blood stained and not actually blood
What is the treatment for Angina Bullosa Haemorrhagica?
Chlorhexidine mouthwash- to use when symptomatic
May recur
No obvious aetiological factor
Reassure patient that disease is benign
What is direct immunofluorescence?
Useful test in diagnosing immunobullous conditions
Highlights an antibody bound to tissue
Preferred when first diagnosing a condition
What is indirect immunofluorescence?
Highlights a circulating antibody not yet bound to the tissue
Detected by immunofluorescence from a plasma sample
Not always useful for diagnosis- often good for monitoring disease activity
