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5006 Oral Surgery > Vesiculobullous disorders > Flashcards

Vesiculobullous disorders Flashcards

1
Q

Vesiculobullous disorders

A

Mucocutaneous disorders
blister formation, vesicles, ulcers, erosions

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2
Q

Vesiculobullous lesions

A

Bulla (visual accumulation of fluid within the epi >0.5cm)
Vesicle (<0.5)
Ulcer (loss of epi, often with underlying tissue loss)
Erosion (loss of epi, follows a blister, heals without scarring)

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3
Q

Infectious agents

A

Herpes simplex
Varicella Zoster infection
Hand, foot and mouth disease
Herpangina
Measles

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4
Q

Immune mediated conditions

A

Erythema Multiforme
Pemphigus vulgaris
MMP
Dermatitis Herpetiformis
Linear IgA disease

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5
Q

Genetic conditions

A

Epidermolysis bullosa

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6
Q

Sub-epithelial bullous disorders

A

Pathology at level of attachment of epithelium and basement membrane
Erythema Multiforme
MMP
Dermatitis Herpetiformis
Linear IgA disease
Bullous lichen planus
Angina bullosa haemorrhagica
Epidermolysis bullosa

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7
Q

Intraepithelial bullous disorders

A

Pathology due to connections between epithelial cells
Pemphigus
Herpes Virus Lesions
Coxsackie virus

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8
Q

Erythema Multiforme

A

Mucocutaneous disorder
Young adults
M>F
Acute onset
Self limiting

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9
Q

EM Aetiology

A

Genetic
Microorganisms
Drugs
Chemicals
Immune factors

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10
Q

EM Clinical Presentation

A

Generally unwell
Lymphadenopathy
Widespread painful oral ulceration
Serosanguinous exudate on lips
Skin involvement
Ocular involvement
Genital involvement

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11
Q

EM Diagnosis

A

Clinical
Serology
Biopsy

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12
Q

EM Diagnosis

A

Opthalmic opinion
Self limiting
Supportive care
Antiseptic MW
Antimicrobials
Recurrent cases prophylaxis

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13
Q

Angina bullosa haemorrhagica

A

Blood filled blisters
Prodromal symptoms
prevalence uncommon
F>M
older age

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14
Q

ABH Aetiology

A

Unclear
Trauma
Corticosteroid inhalers

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15
Q

ABH Clinical Presentation

A

Rapid onset of blood filled blister formation
Non-keratinised mucosa
Break down to form large ulcers which are usually painful

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16
Q

ABH Diagnosis

A

History
Clinical Presentation
Bloods

17
Q

ABH Management

A

Reassurance
Airway
Analgesics

18
Q

Mucous Membrane Pemphigoid

A

Immune mediated sub-epithelial bullous disease
Autoantibodies are directed against epithelial basement membrane zone proteins (antigens)
Immune deposits result in split at basement membrane (sub epithelial split)
Affects mucous membranes +/- skin

19
Q

MMP Aetiology

A

> 50 yrs
F>M

20
Q

MMP CP

A

I/O
Mucosal pain
Tense bullae or vesicles which rupture to produce irregular erosions
Scarring
Desquamative gingivitis
E/O
Nasal involvement (erosions)
Genital involvement (painful erosions)
Skin involvement (tense blisters)

21
Q

MMP Ocular involvement

A

Conjunctiva
Entropium with trichiasis
Symplepharon
Blindness

22
Q

MMP Diagnosis

A

Clinical Presentations
Biopsy
Nikolsky positive
Immunofluorescence

23
Q

Immunofluorescence

A

Relies on the use of antibodies to label a specific target antigen with fluorescent dye.
Allows visualisation of the target distribution in the sample under a fluorescent microscope.

24
Q

What is the difference between direct and indirect immunofluorescence?

A

Direct: perilesional tissue/antibody binds to target antigen/less sensitive test than indirect

Indirect: serum sample/two stage process/more sensitive

25
Q

Management of MMP

A

Local: meticulous oral hygiene/SLS free tp/Analgesic mouth rinses/topical corticosteroid preparations

Systemic: prednisolone/azathioprine/mycophenolate mofetil

26
Q

Pemphigus Vulgaris

A

Potentially life threatening chronic autoimmune disease. Characterised by epithelial blistering of mucocutaneous surfaces. Antibodies are directed against desmosomes causing acantholysis. Immune deposits result in an intrapeithelial split.

27
Q

PV Epidemiology

A

0.5-3.2 cases per/100 000
40-60 year olds
M:F

28
Q

PV Aetiology

A

Drugs
Systemic conditions

29
Q

PV CP

A

Fragile bulla
Large painful irregular erosions
Desquamative gingivitis
Nikolsky sign

30
Q

PV Diagnosis

A

Clinical presentation
Confirmed on biopsy

31
Q

PV Histology

A

Intraepithelial separation (acantholysis)
Tomb stone appearance

32
Q

Management of PV

A

Local: good oral hygiene/SLS free tp/antiseptic mouth rinse/topical steroid preparations

Systemic: corticosteroids/azathioprine/rituximab/mycophenolate mofetil

5006 Oral Surgery (12 decks)

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