FPC 4 Pathology: Autoimmune Diseases

Superficial peeling of epithelium, may involve the formation and rupture of mucosal vesicles

Manifestation of a vesiculo erosive condition

desquamative gingivitis

Desquamative gingivitis is a ____ diagnosis only

clinical

What diseases can have desquamative gingivitis

- erosive lichen planus and lichenoid mucositis

- lupus

- GVHD

- benign mucous membrane pemphigoid and pemphigus vulgaris

- erythema multiforme

If a patient has desquamative gingivitis, you should biopsy

2 areas

What are the solutions the 2 biopsy samples go into

formalin and michel's solution

Should you biopsy the ulcer

no

What kind of testing does desquamative gingivitis undergo

direct immunofluorescence

Common, chronic mucocutaneous condition, immune mediated

lichen planus

What population is lichen planus seen in

middle aged females

What are the oral lesions like in lichen planus

reticular and erosive

What are the skin lesions like in lichen planus

purple, pruritic, polygonal papules

What is a differentiative sign of lichen planus

Wickham striae

Reticular lichen planus

asymptomatic Wickham striae

Erosive lichen planus

symptomatic Wickham striae

What are the histological features of lichen planus

- degeneration of the basal cell layer

- saw-toothed rete ridges

- band-like inflammatory infiltrate

What is the treatment for reticular lichen planus

no treatment needed

What is the treatment for erosive lichen planus

- topical or systemic corticosteroids

- topical immunomodulators

What does chronic ulcerative stomatitis clinically and histologically mimic

erosive lichen planus

What population is chronic ulcerative stomatitis commonly seen in

adult women in their 60s

What is the treatment for chronic ulcerative stomatitis

antimalarials like hydroxychloroquine

What population is mucous membrane pemphigoid seen in

females

Where are mucous membrane pemphigoid lesions seen in the mouth

buccal mucosa, soft palate, gingiva

How are mucous membrane pemphigoid lesions manifested ocularly

symblepharons

What is a positive sign for oral mucous membrane pemphigoid lesions

nikolsky

What are the histological features for mucous membrane pemphigous

- subepithelial clefting

- variable inflammation

- antibodies at the basement membrane

What is the treatment for mucous membrane pemphigous

corticosteroids, immunomodulators, referral to opthalmologist

Uncommon acantholytic antibodies to intracellular desmosomes

pemphigus

What population is pemphigus usually seen in

middle aged eastern european/jewish females

What are the oral lesions of pemphigus like

bullae that don't last long and ulcers that are slow to heal

What is a positive sign for pemphigus

nikolsky

What are the histological features of pemphigus

- intraepithelial separation

- Tzanck cells

- tombstones or hobnails

- desmosome attack

What is the treatment for pemphigus

corticosteroids and immunosuppressants

Most common collagen vascular or connective tissue disease in the US

lupus

Multisystem lupus disease

Butterfly malar rash

systemic lupus erythematosus

What are the oral lesions of SLE

lichenoid, ulcerative, desquamative gingivitis

Oral lesions that are identical to erosive lichen planus

chronic cutaneous lupus erythematosus

Skin lesions are most prominent, presentation is intermediate between SLE and CCLE

subacute cutaneous lupus erythematosus

How do you diagnose chronic cutaneous lupus erythematosus

clinical symptoms, blood tests

What kind of blood tests are used in diagnosing CCLE

- immunofluorescent studies

- ANA

- anti-double stranded DNA

- anti-sm antibodies

What is the treatment for CCLE

- avoid sunlight

- calcineurin inhibitors

What is the treatment for severe lupus

steroids or immunosuppressants/modulators

What is the treatment for mild lupus

NSAIDs and antimalarials

Recipients of allogeneic bone marrow transplants

graft versus host disease

What type of GVHD is this

- develops within 100 days of the transplant

- mild cutaneous rash

- sever sloughing

acute

What type of GVHD is this

- Develops more than 100 days after transplant

- Can also develop after non-resolving acute GVHD

- Skin involvement may resemble lichen planus

chronic