Vesiculobullous II

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Oral Pathology I
Third Year

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  • MMP: cicatridal pemphigoid, benign mucous membrane pemphigoid, ocular pemphigus, childhood pemphigoid, mucosal pemphigoid, and when it affects gingiva exclusively, gingivosis and desquamative gingivitis.
  • Vesiculobullous II

    1. 1. By Dr. Wael Mohamed Swelam
    2. 2. References
    3. 3. To understand how Immunologic vesiculobullous diseases develop we should be aware of 1. Normal structure of epithelium 2. The pathogenesis of autoimmune diseases
    4. 4. To understand how Immunologic vesiculobullous diseases develop we should be aware of 1. Normal structure of epithelium 2. The pathogenesis of autoimmune diseases
    5. 5. Immunologic Vesiculo-Bullous diseases Bullous Pemphigoid Mucous membrane Pemphigoid MMP Pemphigus x x Lamina Lucida Lamina densa Linear Immunoglobulin
    6. 6. Vulgaris Foliaceus Erythematous Vegetans Circulating B cell mediated autoantibodies of IgG reactive against epithelial desmosome-tonofilament complexes. complexes Protein target: Desmoglein 3 (Cadherin family) found in basal and lower prickle cells x x
    7. 7. Vulgaris Foliaceus Erythematous Vegetans Circulating B cell mediated autoantibodies of IgG reactive against epithelial desmosome-tonofilament complexes. complexes Protein target Desmoglein 3 (Cadherin family) Genetic and ethnic factors (common in Ashkinazic Jews) Pathogenesis 1. Circulating autoantibodies, bound to target antigen 2. They activates an epithelial intracellular proteolytic enzymes acting on desmosome-tonofilament complex 3. Resulting in dissolution & disruption of intercellular junction and loss of cell to cell adhesion Autoantibodies
    8. 8. Circulating auto antibodies Epithelial cells Stimulate Intracellular proteolytic enzymes Loss of cell/cell adhesion Activate Destruction of desmosome/ tonofilament complex Desmoglein 3 Dissolution & disruption
    9. 9. Clinical features: 1) Lesions start as short-lived vesicles/bullae that rapidly rupture leaving ulcers 2) 60% of the lesions start intraorally usually one year before skin lesions 3) Painful ulceration result in sever debilitation, fluid loss and electrolyte imbalance, 4) Only Pemphigus vulgaris and P. vegetans (very rare) involve oral mucosa 5) Common intraoral sites are soft palate, buccal mucosa, floor of the mouth 6) No sex predilection, common at 4th~5th decades 7) Positive Nikolsky’s sign
    10. 10. Histopathological features: a) Intraepithelial clefting b) Bullae are suprabasilar c) Basal layer remain attached to basement membrane d) Loss of desmosomal attachment result in free floating, or acantholytic “Tzanc cells” e) P. foliaceus & P. erythematosus involve upper prickel cell layer
    11. 11. Immunopathological features: a) +ve direct immunoflurescent testing b) Demonstrates intercellular autoantibodies of IgG, Complement-3, and less commonly IgA C3 2014

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