Oral Med: Oral Ulceration Flashcards
Behchets, RAS, Pemphigus, Pemphigoid
Autoantibodies seen in Pemphigus Vulgaris
Desmoglein 3 (DSG 3).
The disease which involves an autoimmune reaction that occurs at the level of the basement membrane
Mucous Membrane Pemphigoid.
MMP is associated with autoantibodies recognizing hemidesmosomal components of the epidermal basement membrane. The antigens are mainly, BPAG1 found in the intracellular domain of the hemidesmosome and BPAG2 found along the plasma membrane of the hemidesmosome.
Which layer of epidermis is affected by autoantibodies seen in Pemphigus Vulgaris
In patients with pemphigus vulgaris, DSG3 autoantibodies act against the desmosomal glycoprotein desmoglein 3 (Dsg3) in the basal and immediate suprabasal layer of the deeper epidermis, leaving the superficial epidermis intact.
Name a disease which is caused by an immune-mediated small-vessel systemic vasculitis
Behcet’s Disease
Classify Recurrent aphthous Ulcers
by types, size, number, site & incidence
Types: Minor / Major / Herpetiform Size: 3-7mm/ > 10mm/ 1-2mm Number: 1-5 / 1 / dozens Site: Non keratinized mucosa (Labial, Cheek); Masticatory Mucosa (Dorsum of the tongue, gingiva)/ Non keratinized mucosa Incidence: common, uncommon, uncommon
What investigations should be done for RAS
Blood tests to investigate B12, Folate, and Iron deficiency.
What is the treatment for RAS
Reassurance, Corticosteroid oromucosal tablets, Triamcinolone dental paste, Salicylate gels
What specific treatment would you suggest for herpetiform aphthous ulcers
Tetracycline mouthwashes. 250mg mixed with water and held in the mouth for 3 minutes.
How would you treat major aphthous ulcers
Azathioprine, Cyclosporin, Colchicine and Dapsone. Thalidomide is most reliably effective.
what is the triad that describes Behcet’s disease
oral aphthous stomatitis, genital ulcers and uveitis.
Define Behcet’s Disease
It is a systemic vasculitis of small blood vessels affecting multiple organ systems.
What is the commonest skin manifestation of Behcet’s disease
Erythema Nodosum
What are the International criteria for diagnosing Behcets disease
Oral Aphthous Ulcers, Genital Ulcers, Ocular lesions, skin lesions (erythema nodosum) Vascular manifestations (DVT, Superficial phlebitis, thrombosis of large veins, arteries, and aneurysms. (total score of 4 with the first 3 scoring 2 each)
What HLA type is associated with Behcets
HLA B51; Presence can predict ocular lesions
How would you treat a case of Behcets Diesease
Ciclosporin and Tacrolimus with steroids for acute exacerbations. Thalidomide or topical tacrolimus are most effective for oral ulcers. Anti TNF (Infliximab)
