Path 2: Vesiculobullous Diseases

Front 1

Primary Herpes:

1) What are they?
2) Where do vesicles occur?
3) What does it ALWAYS ulcerate?
4) Other symptoms?
5) Who does it usually affect?
6) Do the lesions heal well?
7) What kind of tissues do initial lesions prefer?
8) Often causes what in gingiva and what on lip?
9) What would you see on a titer?

Back 1

1) Clusters of vesicles that form and colaesce into irregular shallow ULCERS. Herpes = creep
2) All mucosal surfaces + sometimes skin
3) Marginal gingiva
4) Fever, lymphadenopathy, swallowing difficulties
5) Young children
6) Heal completely if not traumatized
7) Inflamed tissues (erupting thirds, palatal of max centrals)
8) Gingival hypertrophy (opposite of ANUG), lip ulcers
9) Anti-IgM antibody

Front 2

Primary Herpes:

1) in adults, can present with primarily involvement of what part of the body?
2) What is constant for all primary HSV patients?

Back 2

1) Pharyngeal
2) Coated tongue

Front 3

1) Treatment of primary herpes in children?
2) Treatment of primary herpes in adults?

Back 3

1) Acyclovir elixir 200 mg/5cc (banana flavored), 1 tsp rinse 30 seconds and swallow 5x/day for 7 days
2) Valcyclovir 1 gram BID for 10 days, significantly reduces incidence of recurrences

Front 4

Secondary herpes:

1) Where does it occur?
2) What are the 2 forms?
3) What do they look like?
4) Tx in adults? How does it affect the herpes?
5) Tx herpes labialis?
6) Suppression tx for secondary herpes? Who is it for? __% reduction in recurrence?
7) Suppression post dental tx herpes?

Back 4

1) Bound down tissue (gingiva, palate)
2) Umbilicated, ulcerative (more common)
3) Short lived vesicles that coalesce
4) Docosanol (Abreva) 10% cream - apply 5x/day at first sign - shortens healing time + duration of symptoms by 3 days. Not for mucous membranes
5) Valcyclovir 500 mg BID for 5 days. 1 day tx: Valtrex 2 gms BID, lesion duration 1 day less, initiate treatment at first sign of lesion
6) Valcyclovir 500 mg or 1 gram QD x 4 months, patients with 6-8 outbreaks/year. 53% reduction in recurrence
7) Valtrex 2 gms BID day of procedure, 1 gm bid next day. Lysine 1 gram before breakfast, avoid arginine rich foods, double dose for 4 days if you get a blister.

Front 5

Herpes zoster:

1) Follows distribution of?
2) Starts with?
3) Length compared to H. simplex?
4) Older patients liable for?
5) Expect 10% to have what occurrence?
6) Only 50% of individuals who live beyond age __ years can expect to develop zoster

Back 5

1) Trigeminal nerve
2) Burning, then clusters of vesicles
3) Much longer
4) Post herpetic neuralgia (unless they use antivirals)
5) Develop vesicular eruptions over 1+ dermatomes
6) 80

Front 6

Herpes zoster:

Clinical course?

Back 6

1) 1-7 days prodromal itch, tingling pain. 10% simultaneous itch, burn, pain and vesicles
2) Crust 1-2 weeks
3) Complete heal 2-4 weeks

Front 7

Herpes zoster:

1) Complications?

Back 7

1) Hyperesthesia, facial scarring w/ depigmentation, loss of hearing, conjunctivitis. In a few cases, post-herpetic alveolar necrosis and spontaneous tooth exfoliation.

Front 8

Mucous membrane pemphigoid:

1) 50-75% of ________ patients
2) What are pathognomonic? What's another key sign?
3) In 2/3rds of the patients, lesions are limited to?
4) How to diagnose?
5) In 14%, what is affected?
6) What is the definition of this disorder?
7) What are the most common target antigens? What may the second most common one be involved with?
8) Tx of mild local mucous membrane pemphigoid?

Back 8

1) Desquamative gingivitis
2) Bloody blisters. Nikolsky sign
3) Gingiva
4) Perilesional Bx, DIF
5) Eye (symblepharon) - can cause blindness
6) Chronic vesiculobullous autoimmune disorder involving antibodies directed against hemidesmosomes in basement membrane of epithelium
7) BP 180 - most common. Laminin 5 (epiligrin) - second most common - increased risk of unreleated solid tumor malignancy, may be more widespread with ocular, laryngeal, and intranasal involvement
8) Moderate to high potency topical corticosteroids => dapsone => tetracycline => oral corticosteroids

Front 9

1) If you do IF and see staining in the roof of the epithelium, what disease can it be? What antigens light up?
2) If the staining's in the floor, what can it be?

Back 9

1) Bullous pemphigoid, mucous membrane pemphigoid, pemphigoid gestationis, linear IgA, lichen ruber pempigoides. BP180, BP230
2) Mucous membrane pemphigoid (laminin 332), epidermolysis bullosa acquisita

Front 10

Mucous membrane pemphigoid:

1) What will exacerbate the condition? what will help?
2) What kind of lesions do you see with extensive disease?
3) T or F: Skin lesions are rare but do occur. Where?
4) Tx for mucous membrane pemphigoid?
5) What part of the body must you get checked?

Back 10

1) Trauma. Good OHI and frequent prophy
2) Eye lesions
3) T - face or other mucous membranes
4) Dapsone effective but <hemoglobin, prophy and OHI, MMP inhibitors (periostat), peridex, topical clobetasol gel 0.05% in trays bid x 2 weeks, then w/out trays or else get atrophy.
5) Eyes

Front 11

Pemphigus Vulgaris:

1) Skin disease but 60% begins where?
2) Goal?
3) Disease itself was previously threatening because? Now, __% mortality from treatment (____)
4) What is the intiial symptom?
5) This is in the d/d for _____-
6) Target in epithelial attachment apparatus in the MUCOSAL form?
7) Target with MUCOCUTANEOUS form? What kind of split does this cause?
8) What kind of pattern do you see in the salt split?
9) Tx?

Back 11

1) Oral cavity
2) Catch it before it gets to skin, becomes widespread
3) Electrolyte imbalance and infection. 6%, steroid
4) Vesicle or blister that ruptures quickly in the mouth (lasts longe ron skin). Becomes widespread and POSITIVE NIKOLSKY signs like pemphigoid
5) Desquamative gingivitis
6) Desmoglein 3 of desmosome (various components of BMZ of hemidesmosome)
7) Desmoglein 1+3 (causes SUPRAbasilar split)
8) Tombstoning
9) No cure currently available, but "sustained remission" is possible. Systemic corticosteroids (prednisone) + immunosuppression (steroid apring), most recent IV immunoglobin + Rituximab. Refer to derm and ophthalmologist for evaluation