Vesiculobullous Diseases Flashcards
Pemphigus vs Pemphigoid
Age
Location of clefting
Where does immune staining attach
Which has lesions that rupture and can coallesce to form large ulcers with gray surface
Which has lesions that bleed
Age
- Younger 30-40 = Pemphigus
- Older 50-60 = Pemphigoid
Location of clefting
- Pemphigus: intraepithelial (Desmosomes)
- Pemphigoid: basement membrane (Hemi-desmosomes)
Where does immune staining attach
- Pemphigus: between epidermal cells
- Pemphigoid: basement membrane
Which has lesions that rupture and can coallesce to form large ulcers with gray surface
- Pemphigus
Which has lesions that bleed
- Pemphigoid
Oral Lichen Planus
- Age
- Histology keys (3)
- Immunoflourescence binds what?
- Which sybtype is similar to pemphigous/pemphigoid
- Age 5-6th decades
- Histology keys (3)
- Hyperkeratosis
- Sawtooth retes ridges
- Lymphocyte invasion
- Immunoflourescence binds what?
- Fibrinogen
- Which sybtype is similar to pemphigous/pemphigoid
- Bullous
Erythema multiforme
- What type of hypersensitivity
- Mediated by which Ab
- Types (3)
- Characteristic skin finding
- Tissues affected
- Management
Erythema multiforme
- Type III hypersensitivity
- IgM
- Types
- mild = EM
- Moderate = Steven-Johnson
- Severe = Toxic Epidermal Necrolysis
- Characteristic skin finding
- Target lesion
- Tissues affected
- all mucosa
- Management
- Stop all medications
- Macrolides or doxycycline for prophylaxis against mycoplasma
- Fluid rescucitation, Tube feeds, supportive
Epidermolysis bullosa
- Incidence
- Inheritance
- Basic pathophys
- Longterm sequellae
Epidermolysis bullosa
- 1:50,000
- Depends on subtype, most common is dominant mild form
- Basic pathophys = linking protein between epidermis/dermis
- Longterm sequellae
- Related to constant circatrial healing, joint restriction, trismus
Herpes Simplex
- Common name
- Does it have prodromal period?
- Name of primary infection
- Name of recurring
- HSV subtype responsible
Herpes Simplex
- “Cold Sore”
- Prodromal: fever, blister
- Herpes gingivostomatitis
- Herpes labialis
- 90% HSV-1, 10% HSV-2
Herpangina
- Causative agent
- Clinical presentation
Herpangina
- Coxsackie A
- Herpangina lesions confined to soft palate/tonsil pillar
Hand-Foot-Mouth
- Causative agent
- Clinical presentation
Hand-foot-mouth
- Coxsackie A
- Ulcers more widespread than herpangina, include the lips
Aphthous stomatitis
- Causative agent
- Subtypes and clinical presentation
- Duration
- Management
- If recurrent, must investigate which systemic diseases
- T-cell mediated (stress, dental procedure, hormone imbalance, nutritional deficiency)
- Minor
- <10mm
- yellow-gray ulcer with erythema hala
- Non-keratinized mucosa
- Major
- >10mm
- also yellow-gray ulcer, erythema halo
- Occurs anywhere
- Herpetiform
- Multiple clusters of lesions 1-3mm
- Most severe form
- Occus anywhere
- Severe forms can scar, take 1 month to improve
- Management:
- 0.01% decadron elixir
- 0.05% betamethasone or clobetasol
- Recurrence can be due to:
- Bechets
- IBD
- Reiters
Behcet syndrome
- What surface protein is responsible for disease
- Clinical presentation, locations
- Clinical diagnostic maneuver
- HLA-B5.
- The aphthi are larger and located more in the soft palate, there are genital ulcerations, cutaneous lesions
- Exaggerated response to subQ injection of an in inert substance
Reiters Syndrome
- Clinical presentation
- Gender
- Associated surface protein
- Causative agents
- Management
Reiters syndrome
- Reactive arthritis, inflammed urethra, conjunctiva, oral ulcers
- Males
- HLA-B27
- Chlamydia, Shigella, Strep, Salmonella
- Treat infection and NSAIDS
Pemphigoid subtypes
Which affects skin?
Which affects mucosa, conjunctiva?
What causes blindness?
Bullous Pemphigoid = Skin
Cicatricial pemphigoid = mucosa, conjuctiva
Blindness caused by scarred conjunctiva that eventually covers cornea, iris, pupil. Also causes foreshortening via conjunctival shortening
Lupus Erythematosis
- What cell type is responsible
- Most common subtype
- Cutaneous presentation
- Oral presentation
- Lab findings
- B-cell overproduces antibody
- SLE, also most severe
- Red scaly patches
- Oral lesions similar to lichen planus, usually painless
- Usually ANA positive
