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Flashcards in vesiculoerosive, derm mucosal diseases Deck (48)
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what is direct immunofluorescence

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


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


what are good terms for intramural changes due to vesiculobullous conditions

desquamative gingivitis and desquamative mucosa


where is separation in pemphigus vulgaris

intraepithelial. the antibodies attack desmosomes


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


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


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


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


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


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


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


in cicatricial pemphigoid where does separation usually occur

between the basement membrane and basal layer of epithelium


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


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


what are the two types of lichen planus

reticular and eosive


what are the immunoflouresent results of oral lichen planus

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


when do you treat oral lichen planus

when it is symptomatic


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


What are the types of erythema multiforme

Minor, major TEN


Describe presentation of EM minor

target lesions of skin


what usually is the trigger of EM minor

secondary HSV


describe presentation of EM major

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


What is common trigger of EM major

usually medication, often a relatively common one such as tylenol


What is TEN

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


which form of candidiasis is associated tiwh invasion of tissues

hyphen form (yeast form is innocuous)


What factors determined clinical evidence of infection

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


what are the four clinical patterns of candidiasis

• Pseudomembranous • Erythematous • Chronic hyperplastic • Mucocutaneous



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


Where are the most common sites for pseudomembranous candida

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


what are symptoms of pseudomembranous candidiasis

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