Oral Medicine Tutorial 2

Question 1

what is MMP

Answer 1

a group of autoimmune bullous characterised by subepithelial blisters

Question 2

who does MMP usually affect

Answer 2

older populations
women more than men

Question 3

what is the pathogenesis of MMP

Answer 3

autoantibodies are directed against specific adhesion molecules located in hemi-desmosomes of basal membrane

Question 4

what are intra-oral manifestations of pemphigoid

Answer 4

patchy or generalised gingival sloughing
superficial ulcers and erosions

Question 5

what is the extra-oral manifestation of pemphigoid

Answer 5

recurring vesicles or bullae affecting mucosa or skin
tends to scar
the blisters break which leave painful ulcers

Question 6

what is Nikolsky’s sign

Answer 6

formation of new bullae on application of pressure to skin

Question 7

in which diseases is Nikolsky’s sign present and absent

Answer 7

present in MMP
absent in bullous pemphigoid

Question 8

what is shown in direct immunofluorescence in MMP

Answer 8

linear deposition of IgG along basement membrane

Question 9

what is shown in indrect immunofluorescence in MMP

Answer 9

usually negative as serum contains the anti-adhesion antibodies at low titres

Question 10

what is pemphigus vulgaris

Answer 10

autoimmune blistering disease classified by flaccid blisters

Question 11

what is the pathogenesis of PV

Answer 11

cutaneous desmoglein-1 is expressed in the whole epidermis (skin lesions only) but desmoglein 3 is found in the lower epidermis (skin and mucosal membrane lesions)

Question 12

what is the extra oral presentation of PV

Answer 12

flaccid skin blisters which develop to oozing erosions

Question 13

what is the intra-oral presentation of PV

Answer 13

painful and refractory oral erosions

Question 14

where is direct immunofluorescence done in PV

Answer 14

in an area of unaffected skin

Question 15

what is the usual immunosuppressive treatment in MMP

Answer 15

high dose topical corticosteroids
prednisolone
Intravenous immunoglobulin

Question 16

what is the immunosuppressive treatment in PV

Answer 16

corticosteroids
azathioprine
Rituximab (monoclonal antibody)

Question 17

what is clobetasol

Answer 17

high dose topical steroid that can help manage desquamative gingivitis but have a candida infection risk

Question 18

what is the prescribed dose for prednisolone in treating MMP

Answer 18

0.5/1mg per kg per day

Question 19

what is the prescribed dose for azathioprine for management of MMP

Answer 19

1-2mg per kg per day initially
can be raised to 5mg per kg per day

Question 20

what is the intravenous immunoglobulin treatment for MMP

Answer 20

400mg per kg per day for 5 days every 4 weeks

Question 21

what biological therapies are used in MMP

Answer 21

etanercept used in patients who fail to respond to immunosuppressants

Question 22

what is erythema multiforme

Answer 22

acute immune mediated disorder affecting the skin and mucous membranes

Question 23

what is EM triggered by

Answer 23

hypersensitivity reactions to various antigens

Question 24

what is the pathogenesis of EM

Answer 24

when the immune responds to an antigen being targeted by antibody a large complex is formed which cannot pass through capillaries
it gets wedged into tissue and activates complement - perivascular inflammatory response
causes blistering of tissue

Question 25

give three triggers for EM

Answer 25

herpes simplex virus
NSAIDs
food additives

Question 26

how does EM present in the mouth

Answer 26

diffuse oral erythema and multi focal superficial ulcerations

Question 27

how does EM present extra-orally

Answer 27

target lesions on the skin

Question 28

what would you expect to see in a patient with EM histologically

Answer 28

acanthosis and elongation of rete ridges

Question 29

what is the treatment options for EM

Answer 29

discontinue any triggers
systemic steroids - 40-60mg prednisolone daily
antiviral - aciclovir 400mg twice daily
immunosuppressive - azathioprine 100-150mg per day