Vesiculobullous & Immune Disease

Question 1

what are examples of local immunological oral diseases?

Answer 1

• aphthous ulcers
• lichen planus
• orofacial granulomatosis

Question 2

what are examples of systemic diseases that have local effects of oral disease?

Answer 2

• erythema multiforme
• pemphigus
• pemphigoid
• lupus erythematosis
• systemic sclerosis
• Sjogren’s syndrome

Question 3

what type of hypersensitivity disease is erythema multiforme?

Answer 3

Type 3
- related to antigen antibody complexes

Question 4

What type of immunogenic disease do aphthous ulcers come under?

Answer 4

cell mediated immunity

Question 5

What type of immunogenic disease does orofacial granulomatosis come under?

Answer 5

cell mediated immunity

Question 6

Many blistering skin conditions also…

Answer 6

Affect the mouth!
- skin & oral/genital mucosa share many common antigens & epitopes

Question 7

what protein is the target for many of the antibodies involved in immunobullous diseases?

Answer 7

Desmoglein

Question 8

What is erythema multiforme?

Answer 8

Spectrum disorder of Immunogenic related skin & mucosa ulceration with variable orofacial involvement

Question 9

What is the aetiology of erythema multiforme??

Answer 9

• drugs
• herpes simplex
• mycoplasma

Question 10

Which sex is more likely to suffer from erythema multiforme?

Answer 10

Males > females

Question 11

How is erythema multiforme treated with drugs?

Answer 11

1. prednisolone (up to 60mg a day)
2. systemic aciclovir

Question 12

What is angina bullosa haemorrhagica?

Answer 12

“blood blisters” in the mouth
- rapid onset appear in a few minutes
- last about 1 hour then burst

Question 13

What might trigger angina bullosa haemorrhagica?

Answer 13

eating

Question 14

Where are the most common sites of angina bullosa haemorrhagica?

Answer 14

buccal mucosa and soft palate

Question 15

how is angina bullosa haemorhagica managed?

Answer 15

• no treatment available
• reassure patient that diseaae is benign
• explain triggers

Question 16

What is pemphigoid characterised by?

Answer 16

SUB epithelial antibody attack
- thick walled blisters across full epidermis

Question 17

what is citatritial pemphigoid?

Answer 17

mucosal lesions with scarring

Question 18

in suspected pemphigoid where should the biopsy be taken?

Answer 18

PERI-lesion biopsy (not directly on ulcer)

Question 19

what is the most useful test for patients with suspected pemphigoid?

Answer 19

direct immunofluorescence

Question 20

what does pemphigoid cause?

Answer 20

separation of the epithelium and connective tissue causing ulcers

Question 21

what immunofluorescence results suggest a patient has pemphigoid?

Answer 21

• linear staining along basement membrane
• C3 & IgG detected

Question 22

what is symblepharon?

Answer 22

binding of eye surface to eyelid due to scarring from pemphigoid

Question 23

how is pemphigoid managed?

Answer 23

• steroids
• immune modulating drugs eg azathioprine or mycophenolate

Question 24

what is the commonest form of pemphigus?

Answer 24

Pemphigus vulgaris

Question 25

what is pemphigus?

Answer 25

intraepithelial bullae (presents as mucosal erosion as cells are gradually lost from the epithelial surface)

Question 26

what characteristic cells are seen in pemphigus histologically?

Answer 26

tzank cells

Question 27

how do clinical presentations of pemphigoid vs pemphigus show?

Answer 27

Pemphigoid
- intact bullous

Pemphigus
- eroision of mucosa/skin

Question 28

how is pemphigus treated?

Answer 28

• steroids
• immunosuppressants