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Oral Medicine > Immuno-mediated Oral Diseases > Flashcards

Immuno-mediated Oral Diseases Flashcards

1
Q

What are some LOCALISED immunological oral diseases?

A
  • Apthous ulcers
  • Lichen planus
  • OFG
  • Lupus erythematosus (CDLE)
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2
Q

What are some SYSTEMIC immunological diseases with oral effects?

A
  • Erythema multiforme
  • Pemphigus
  • Pemphigoid
  • Lupus erythematosus
  • Systemic sclerosis
  • Sjogren’s syndrome
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3
Q

What are the causes of recurrent oral ulcerations?

A
  • Trauma
  • Medication
  • Apthous ulcers
  • Lichen planus
  • Viral reactivation (herpes)
  • Vesicullobullous diseases (pehmigus, phemphigoid, angina bullosa haemorrhagica)
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4
Q

What are the types of recurrent apthous stomatitis?

A
  • Major
  • Minor
  • Herpetiform
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5
Q

What are the characteristics of MINOR recurrent apthous ulcers?

A
  • <10mm
  • Oval - RED HALO, YELLOW BASE
  • 1-20 per crop
  • Affects mainly non-keratinising mucosa
  • Heals 1-2 weeks, w/o scarring
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6
Q

What are the characteristics of MAJOR recurrent apthous ulcers?

A
  • > 10mm
  • Oval
  • <5 per crop
  • Affects both keratinising/ non-keratinising mucosa
  • Heals 6-12 weeks, usually scars
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7
Q

What are the characteristics of HERPETIFORM recurrent apthous ulcers?

A
  • <5mm
  • Oval - often fuse into large areas of ulcerations
  • 1-200 per crop
  • Affects non-keratinising mucosa
  • Heal 1-2 weeks, w/o scarring
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8
Q

What is Behcet’s Syndrome?

A
  • Rare, blood vessel inflammatory condition
  • Affects = eyes, joints (arthritis), neurological, GI
  • Ulcerations = oral, genital and skin
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9
Q

What are the causes of recurrent APTHAE ulcerations?

A

Host

  • Genetic
  • Deficiencies (iron, folate, vit b12)
  • Systemic diseases (menorrhagia, chronic GI bleeding, dietary malabsorption, ulcerative colitis)
  • Endocrine disease (?progesterone)
  • Immunity

Environmental

  • Trauma
  • Allergy
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10
Q

What drug therapies may be used for recurrent apthae ulcers?

A

TOPICAL immune-modulating (STEROIDS)

  • Betamethasone mw (0.5mg 3x daily)
  • Beclometasone (brown) inhaler (50ug puffs 3x daily)

SYSTEMIC immune-modulating

  • Systemic steroid (prednisolone)
  • DMARD (azathioprine)
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11
Q

What are Wickham’s striae and which condition is this seen in?

A
  • White lines seen in papules of LICHEN PLANUS
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12
Q

What are the SEVEN types of lichen planus?

A
  1. Reticular
  2. Papular
  3. Plaque
  4. Atrophic
  5. Erosive
  6. Bullous
  7. Desquamative gingivitis
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13
Q

Describe the histology of lichen planus

A
  • Keratosis
  • Atrophic/ hyperplastic epithelium
  • Epitheliotropism (affinity for epithelium; lymphocyte presence)
  • Basal cell liquefaction/ degeneration
  • ‘Blue/ hugging band’ of lymphocytes following fossae of Rete pegs
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14
Q

What are the treatment options for lichen planus?

A

ASYMTOMATIC

  • Observe (6 months, repeat)
  • CHX mw (ensure OH is good)

SYMPTOMATIC

  • Remove cause/ SLS-free toothpaste
  • Topical steroids
  • Systemic steroids
  • Systemic immunomodulation

BOTH
- Betamethasone mw (tablet -> water)

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15
Q

When should a biopsy be taken in a patient with lichen planus?

A
  • EVERYONE = SYMPTOMATIC/EROSIVE type

- SMOKERS = ALL TYPES

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16
Q

What is erythema multiforme?

A
  • Skin condition with unknown cause (most likley immune-complex?)
  • Erythematous lesions seen
  • Can affect lips and anterior part of mouth
17
Q

What is the management for oral manifestations of erythema multiforme?

A
  • Urgent medical therapy = systemic steroids, systemic aciclovir (common end stage of blistering is HSV expression)
  • Encourage fluid uptake (may require IV fluids)
  • Encourage analgesia
  • IF recurrent = consider daily prophylactic aciclovir and allergy testing (benzoates)
18
Q

Where are desmosomes found?

A

WITHIN epithelium layer (simple/ stratified squamous)

19
Q

Where are hemidesmosomes found?

A

BETWEEN epithelium and laminar propria layer

20
Q

What are the types of immunofluorescence testing?

A
  • DIRECT (biopsy to prove antibody attaches to tissues)

- INDIRECT (blood sample for antibody)

21
Q

What is pemphigoid?

A
  • Vesiculobullous disease (blistering disease)
  • Antibody attack of SUB-epithelial layers (hemidesmosomes)
  • Thick-walled blisters are seen, filled with blood

Relatively common

22
Q

What types of pemphigoid are there?

A
  • Bullous pemphigoid (skin)

- Mucous membrane pemphigoid (oral)

23
Q

Describe the histopathology of pemphigoid

A
  • Sub-basal (/epithelial) split, vesicle
24
Q

Describe the appearance of direct immunofluorescence of pemphigoid

A
  • Linear distribution seen (glowing) sub-basal (/epithelial)
25
Q

How is pemphigoid managed?

A
  • Immunosuppressants (steroids, immunomodulating drugs)
26
Q

What is pemphigus?

A
  • Vesculobullous disease (blistering disease)
  • Antibody attack of INTRA-epithelial layer (desmosomes)
  • Thin-walled blisters seen, filled with serous fluid (rarely seen intact)

S = superficial, serous, steroids

27
Q

Describe the histopathology of pemphigus

A

Blister formed entirely WITHIN epithelial layer

28
Q

Describe the appearance of direct immunofluorescence of pemphigus

A
  • “Basket weave” appearance (glowing seen AROUND epithelial cells)
29
Q

What is angina haemorrhagica bullosa?

A
  • Blood blisters in absence of trauma
  • Isolate nature, rapid healing and rare occurrence
  • Commonly seen in soft palate
  • Commonly seen in long-term steroid-using asthmatics
30
Q

What investigations should be considered for suspected angina haemorrhagica bullosa?

A
  • Platelet count
  • Coag screen
  • LFT
  • Blood glucose
  • Immunofluorescence
31
Q

How is angina haemorrhagica bullosa managed?

A

Advise pt to de-roof blister with something sharp (otherwise it will keep filling with blood and grow)

32
Q

What is epidermolysis bullosa?

A

CT disease which causes blistering of skin and mucous membrane

Mild - severe (death at birth)

Oral Medicine (13 decks)

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