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ORAL MEDICINE > VESICULOBULLOUS DISORDERS > Flashcards

VESICULOBULLOUS DISORDERS Flashcards

1
Q

Herpes simplex virus (HSV) signs and symptoms +

A
  • FLUID FILLED blisters that rupture leaving painful ulcers
  • lip erosion
  • primary herpetic gingivostomatitis
  • lymphadenopathy
  • dehydration
  • pyrexia
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2
Q

HSV differential

A

-erythema multiforme (90% of EM pt have HSV)

+PV MMP LP

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3
Q

Management of HSV

A
  • CHX mw for secondary bacterial infection
  • stay hydrated (admission if severe dehydration)
  • aciclovir suspension 200mg in 5ml water 5 times a day (OD) for 5 days
  • prevent spread avoid close contact
  • simple analgesics eg. ibuprofen 0.15% difflam
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4
Q

Vesiculobullous disorder classification

A

INFECTIOUS

  • HSV
  • herpes zoster
  • herpangina

AUTOIMMUNE

  • pemphigus vulgaris
  • mucous membrane pemphigoid
  • dermatitis hepetiformis

IDIOPATHIC

  • drug induced
  • angina bullosa haemorrhagica
  • erythema multiforme
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5
Q

SUBEPITHELIAL VS INTRAEPITHELIAL classification

A

SUBEPITHELIAL

  • Erythema multiforme
  • MMP

INTRAEPITHELIAL

  • HSV
  • PV
  • Herpes zoster
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6
Q

Further questions ask someone with HSV

A
  • have you had HSV before
  • Have you been in contact w someone with HSV
  • did you notice blisters that bursted causing painful ulcers
  • take any medication (eg. erythema multiforme hypersensitivity eg. sulfonamides, penicillin, barbiturates, phenytoin)
  • any rashes on body?- erythema multiforme
  • temperature?
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7
Q

Blister differentials

A
  • Lichen planus
  • PV
  • MMP
  • HSV
  • erythema multiforme
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8
Q

Blister special investigations

A 
Biopsy- Histology of small fresh blister (hematoxin eosin)
-intraepithelial-PV
-subepithelial-MMP
Direct/Indirect immunofluorescence 
Serum- for autoantibodies
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9
Q

Blistering disorder most common at SP HP junction?

A

PV

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10
Q

What causes pemphigus vulgaris

A
  • autoimmune blistering disorder
  • intra epithelial blister
  • caused by circulating/bound tissue igG autoantibodies attacking adhesion proteins of desmosomes (desmoglein 3)
  • strong genetic association
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11
Q

Oral signs of pemphigus vulgaris

A

-Oral blisters rapidly rupture to form painful ulcers
-+ve to nikolskys sign
-desquamative gingivitis
-cutaneous lesions
-blisters are fragile and rupture easily
-dysphagia/odynophagia suggests oesophageal involvement
most common in junction bw HP SP, gingiva and buccal mucosa

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12
Q

What disorders is desquamative gingivitis found

A
  • LP
  • PV
  • MMP
  • DLE
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13
Q

Associations to PV (diet and medication)

A 
DIET
onions
garlic 
leek
mustard
red wine

MEDICATION
sulphyldryl
non-thiol drugs eg. rifampicin/diclofenac

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14
Q

PV special investigations

A
  • Biopsy of peri-lesion and normal tissue
  • fresh blister (not fixed)
  • routine histology with hematoxylin and eosin staining
  • direct IF
  • Blood for FBC and indirect IF
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15
Q

PV treatment

A

-systemic glucocorticoids eg. prednisolone
or
-steroid sparing agents eg. azathioprine
-topical corticosteroids eg. betamethasone 500mcg soluble tablet in 20ml water for QDS 5 days

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16
Q

Mucous membrane pemphigoid

A
  • autoimmune blistering disorder
  • subepithelium
  • 3x more common than PV
17
Q

MMP oral lesions

A
  • +ve to nikolskys sign
  • BLOOD FILLED blisters rupture rapidly leaving painful ulcers
  • desquamative gingivitis
  • lip/skin lesions are
  • ocular lesions are common
18
Q

Question to ask about blisters

A 
site
onset
are the blisters BLOOD FILLED/FLUID FILLED
do the blisters RUPTURE easily- MMP/PV
do you feel chocking
associated with sore bleeding gums?- desquamative gingivitis/primary herpatic gingivostomatitis
any blisters on skin/lip
any associations to eye?
19
Q

what ocular lesions linked to MMP

A
  • chronic conjunctivities
  • xs tearing
  • one eye intially and 2nd eye in 2 years.
  • symblepheron
  • trichiasis
20
Q

MMP other regions

A 
oral
skin
ocular
scalp- alopecia
genital
nasopharynx
21
Q

How to diagnose MMP

A

history and clinical examinatin
biopsy w routine histological staining haematoxylin and eosin
direct IF
(indirect IF not appropriate for MMP)

22
Q

MMP treatment

A

systemic corticosteroids- prednisolone
topical corticosteroids- betamethasone 500mcg soluble tablet in 20ml of water QDS for 5 days
dapsone
anti-inflammatory antibiotics doxycyline/minocycline

23
Q

What is bullous pemphigoid and management

A

erythema/fluid filled blisters on skin
itchy
topical/systemic corticosteroids +anti-inflammatory antibiotics doxycyline and minocycline

24
Q

Angina Bullosa hameorrhagica

A

BLOOD FILLED Blisters
chocking
spontaneous burst and resolve in 7-10 days

25
Q

What blisters are blood filled

A

MMP

angina bullosa haemorrhagica

26
Q

Management of angina bullosa haemorrhagica

A
  • FBC + check coagulation factors
  • difflam 0.15%
  • chlorhexidine mw
  • large intact blisters should be incised to prevent respiratory embarrassment

ORAL MEDICINE (12 decks)

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