Lecture 7 Immune Mediated Disease

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Back 1

Angioedema

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Back 2

minor Recurrent Aphthous Stomatitis

Front 3

Back 3

Major RAS

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Back 4

Herpetiform RAS

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Back 5

Behçets disease

Front 6

Back 6

Lichen planus

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Back 7

Systemic lupus erythematosus (SLE)

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Back 8

Erythema multiforme

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Back 9

Orofacial granulomatosus
Oral menifestions of Crohn's disease

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Back 10

Mucous membrane pemphigoid

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Back 11

Pemphigus vulgaris

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Back 12

Systemic sclerosis

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angioedema

What is it?

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Recurring, rapid swelling of the lips and adjacent
structures in susceptible patients after contact with an
allergen

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angioedema

Types? Which is more common?

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Acquired is more common
Hereditary

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angioedema

some drugs that cause it?

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ACE inhibitors
NSAIDs (aspirin and indomethacin)
Carbamazepine
Cephalosporins
Iodine - contrast media
Barbiturates
Food
(egg, nuts, chocolate,
fish, strawberries etc.)

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Recurrent aphthous stomatitis

sex and age?

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females
children above 5

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Recurrent aphthous stomatitis

types? which one's majority?

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minor (majority)
major
herpetiforme

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Recurrent aphthous stomatitis

aetiology/

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Genetic
immunodeficiency/stress/Psychological
trauma
deficiency in iron, VB12, folate
allergy
hormone
HIV
Sessation of smoking

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Recurrent aphthous stomatitis

Smokers are Risk group?

T/F?

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False

non-smokers

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Recurrent aphthous stomatitis

Recurrent in children?

T/F?

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No

begin in childhood
recurrent in adults

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Minor Recurrent aphthous stomatitis

site?
numbers?
size?
scarring?
healing?

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non-keratinised epithelium
2-5 ulcers
< 1cm
no scarring
healing takes within 14 days

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Major Recurrent aphthous stomatitis

site?
size?
number?
healing?
scarring?

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keratinised and non-keratinised epithelium
1-2 cm
1-2 ulcers
takes 14 days or more
leaves scar

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HerpetiformRAS

incidence
site
number
size
healing
scarring

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10%
keratinised and non-keratinised epithelium
several small ulcers
small 1-2mm
1 to 6 months
may leave a scar

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HerpetiformRAS

is it recurrent?

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yes

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Behçets disease

it is prevalent in Caucasian

T/F?

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false

Turkey and Japan (silk road)

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Behçets disease

sex?

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males

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Behçets disease

clinical features?

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oral/genital ulcers
occular uveitis and blindness
skin pustules, erythema nodusum
joint arthraliga
vascular aneurisms, thrombosis
renal: proteinuria and haematuria
Neuropsychiatric: similar to multiple sclerosis

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Behçets disease

How to diagnose it?

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Recurrent oral ulcers
AND

Two of the following:
Recurrent genital ulcers
Eye lesions
Skin lesions
Positive pathergy test

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Back 29

Oral lichenoid reaction

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Oral lichenoid reaction

aetiology?

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Exposure to dental resto material
Chronic GVHD
HepC V
Drugs: antihypertensive, NSAIDS

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Oral lichenoid reaction

with Hypertension and diabetes is called..

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Grinspan syndrome

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Lichen planus

frequency?

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common

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Lichen planus

uni-lateral or bilateral?

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bilateral

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Lichen planus

location

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buccal and lingual mucosa and gingiva

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Lichen planus

cause?

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due to drug therapy

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Lichen planus

what are the types?

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reticular
plaque like
papular
erosive
ulcerative
bullous

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Lichen planus

what's its prognosis toward malignancy?

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less than 1%

Front 38

Lupus erythematosus

frequency?

Back 38

uncommon

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Lupus erythematosus

What are the types?
Differentiate

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Discoid: single isolated

Systemic: widespread to other parts of the body

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Systemic lupus erythematosus (SLE)

oral menifestation?

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similar to DLE
more ulcerations
Sjogren syndrome

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Lupus erythematosus

Prognosis towareds malignancy?

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Maybe for DLE
No for SLE

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Lupus erythematosus

cause?

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idiopathic

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Lupus erythematosus

sex and age?

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adult females

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Lupus erythematosus

oral lesion location and laterality

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Bilateral
buccal mucosa/gingiva/lip/vermillion

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Erythema multiforme

aetiology?

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not clear
maybe organisms such as HSV
disorder eg hepatitis BCG
drugs eg ABiotics

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Erythema multiforme

oral manifestation?

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Diffuse widespread macules to blisters and ulceration
Swollen and cracked lips with bleeding and crust formation
Pronounced lesions on the non-keratinised mucosae

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Erythema multiforme

Recurrence?

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weeks to years, attacks last for 10-20 days once or twice a year

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Orofacial granulomatosis

Orofacial features?

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facial / labial / gingival swelling
angular cheilitis
cracked lips
mucosal tags
cobble-stoning
CLN enlargement

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Crohn's disease

Orofacial features?

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Swellings of the lips
Angular cheilitis
Oral ulcers
Gingival swellings
Mucosal tags
Folding of mucosa (cobblestone appearance)

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Mucoud membrane pemphigoid (MMP)

Frequency

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Uncommon,

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Mucoud membrane pemphigoid (MMP)

What is it?

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autoimmune disease characterised by damages to hemidesmosomes of basement membrane.

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Mucoud membrane pemphigoid (MMP)

sex?

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females

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Mucous membrane pemphigoid (MMP)

predisposing factors?

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genetic
drugs: furosemide and penicillamine

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Mucoud membrane pemphigoid (MMP)

Oral features:

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erythema, vesicle, bullae, blood filled blisters, ulcer,
desquamative gingivitis

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Pemphigus vulgaris (PV)

what is it?

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Rare autoimmune disease affecting middle aged
from Ashkenazi Jewish, Asian and Mediterranean
descent

Auto-antibodies against desmoglein targeting desmosomes of epithial cells

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Pemphigus vulgaris (PV)

sex?

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females

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Pemphigus vulgaris (PV)

Predisposing factors:?

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genetic
drugs
radiation

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Pemphigus vulgaris

clinical features?

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Blisters and scabs on the skin
Erosions and ulcers of the mucosae of oral cavity,
conjunctiva, nasal cavity, pharynx, larynx, oesophagus,
rectum, genitals
Blisters are thin and easily ruptured

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Pemphigus vulgaris

locations?

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palate, buccal mucosa, lips, gingiva

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Systemic sclerosis

what is it?

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Generalised condition characterised by replacement of the normal connective tissue with dense collagen resulting in fibrosis, loss of mobility and organ dysfunction

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Systemic sclerosis

FEATURES (CREST)

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Calcinosis
Raynaud phenomenon
Oesophageal strictures
Sclerodactyly
Talengiectasia

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Scleroderma:
orofacial features?

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Progressive restriction of mouth opening
 Xerostomia (dryness of the mouth)
 Dysphagia due to oesophageal involvemnent
 Generalised induration of mucosa
 Tongue changes
 Periodontitis
 Temporomandibular joint dysfunction, pain
 Cortical erosion of mandible

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Differentiate between Orofacial granulomatosis and Crohn's disease

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OFG has similar orofacial features as Crohn's but without association with any systemic disorder

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Differentiate between Systemic lupus erythematosus and Discoid lupus erythematosus

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Systemic: more severe. Targets kidneys. Butterfly rash.

Discoid: less severe. Affects orofacial regions only. Scalp, face, oral mucosa, ears