vesiculoerosive, derm mucosal diseases Flashcards Preview

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Flashcards in vesiculoerosive, derm mucosal diseases Deck (48)
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1

what is direct immunofluorescence

a way to stain tissues to search for antibodies by making them flourese. used to detect auto immune disease

2

how do you take a biopsy for immunoflouresence

• Submit half in Michel’s solution – ammonium sulfate solution; transport medium, not a fixative like formalin; allows for “fresh” tissue

3

what are good terms for intramural changes due to vesiculobullous conditions

desquamative gingivitis and desquamative mucosa

4

where is separation in pemphigus vulgaris

intraepithelial. the antibodies attack desmosomes

5

what is the positive nikolsky sign and what does it indicate

– Formation of bullae on previously unaffected skin after application of firm, lateral pressure – Characteristic of pemphigus vulgaris

6

what is usually the first sign of hemp vulgarisms

• Initial presentation may be oral lesions; 50% of patients have oral lesions 1 year or more before onset of skin lesions

7

what are the results of immunoflourecence in pemp vulgarisms

direct and indirect usually positive between epithelial cells. Indirect can also be used to asses tx

8

how do you tx temp vulgaris

Systemic corticosteroids (prednisone) • Combined with other immunosuppressive drugs (steroid sparing): azothioprine • High initial dosing schedule, followed by low maintenance doses for long-term control With corticosteroids, 5% to 10% mortality remains, often from long-term steroid use

9

what is cicatricial pemphigoid

• Autoimmune • Antibodies directed against components of the epithelial basement membrane (subepithelial splitting) • More common than pemphigus, better prognosis cicatrix means scar

10

what sites are usually affected by cicatricial pemphigoid

Oral lesions found in most patients, other sites often found as well (conjunctival, nasal, esophageal, vaginal, laryngeal) • Gingival involvement – desquamative gingivitis, also seen in other conditions

11

what is symblepharon

consequence of cicatricial pemphigoid Adhesion between bulbar and palpebral conjunctivae • Subconjunctival fibrosis – early change • Conjunctiva becomes inflamed and eroded • Repeated healing leads to scarring b/w bulbar and palpebral conjunctiva

12

in cicatricial pemphigoid where does separation usually occur

between the basement membrane and basal layer of epithelium

13

what is the usual immunoflouresent results with cicatricial pemphigod

• Direct immunofluorescence – Continuous linear band along basement membrane zone – 90% of patients – IgG, C3, possibly IgA and IgM • Indirect immunofluorescence – Only 5% of patients

14

Cicatricial Pemphigoid Treatment

• Immediately refer to an ophthalmologist • Treatment is varied, individual – Topical agents (if only oral lesions are present) – Systemic agents: corticosteroids plus other immunosuppressives (cyclophosphamide), dapsone, minocycline or niacinamide make sure ophthalmologist i involved

15

what are the two types of lichen planus

reticular and eosive

16

what are the immunoflouresent results of oral lichen planus

Direct is non specific. positive for fibrinogen along the basal layer

17

when do you treat oral lichen planus

when it is symptomatic

18

what is the tx for oral lichen planus

if concomitant candida present give 2 weeks of anti fungal. f LP still around give topical corticosteroids Lydex gel. if LP still present be concerned for dsplasia

19

What are the types of erythema multiforme

Minor, major TEN

20

Describe presentation of EM minor

target lesions of skin

21

what usually is the trigger of EM minor

secondary HSV

22

describe presentation of EM major

stevens johnson syndrome often in sick pt. Hemorrhagic crusting of lips. Dehydration

23

What is common trigger of EM major

usually medication, often a relatively common one such as tylenol

24

What is TEN

toxic epidermal necrolysis. its lose skin and must be treated like burn patients. no steroids as they are prone to infection

25

which form of candidiasis is associated tiwh invasion of tissues

hyphen form (yeast form is innocuous)

26

What factors determined clinical evidence of infection

• Host immune status • Oral environment • C. albicans strain

27

what are the four clinical patterns of candidiasis

• Pseudomembranous • Erythematous • Chronic hyperplastic • Mucocutaneous

28

PSEUDOMEMBRANOUS CANDIDIASIS

• Best recognized form of candidiasis • Aka “thrush” • White mucosal plaques (cottage cheese) • Plaques can be removed, usually revealing red, irritated tissue

29

Where are the most common sites for pseudomembranous candida

• Most common sites are buccal mucosa, dorsum of tongue, and palate

30

what are symptoms of pseudomembranous candidiasis

Symptoms may include mild chronic burning, bad taste (salty, bitter), “blisters”