????????? Oral Vesiculobullous Diseases

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?????????Oral Vesiculobullous Diseases
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??
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????
????????
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???? Herpes simplex
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?? Chicken pox
???? Herpes zoster
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??????? Allergic medicamentosus stomatitis
???? Erythema multiform
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• ?????
• ?????
• ?????
• ???
• ???

????
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?. ??

1. ????

1. ????

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• ? vesicle ????????????
• ?? water blister ???????
• ?? blood blister ???????
• ?? pustule ???????
• ?? bulla ?? gt 5mm

???? ????
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?? Water blister
?? Blood blister
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???? subepithelial bulla
???? intraepithelial bulla
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?.???(pemphigus)

• 1. ??(preface)

• ?? (severity)
• ?????
• ??(corticosteroid) ?????????

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• ??(chronicity)
• ???? ????
• ?? ??????
• (skin-mucosa associated disease )
• ?????????
• ?????????

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??? pemphigus vulgaris ??? pemphigus vegetans ?
? pemphigus foliaceus ??? pemphigus erythematous

• ??
• classification

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• 2. ??(pathogeny) ??
• ??????? autoimmune disease
• ???????????????
• 3. ???? (clinical manifestation)

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• 4. ??(pathology)
• ???? ???? ??????

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• 5. ??(diagnose)
• 1)??
• 2)???? ????????? ??
• ???????????
• ?????? ???? ? ???????
• ??????? ?????? ???

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• 3)????
• ??
• ?????????????(?????)
• ???????? ???
• ?????????????????
• 4)???????

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• 6. ???? (differential diagnoses)

??? ???? ????? ????????
????
????
????
????
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• 7. ?? (treatment)

1. ??????? ?????? ?????? ??
2. ???? ?? ?????? ?? ?? ??
   ?????????????? ??????????? ??????????

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1. ??0.5?????? ?????
2. ????

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??????????
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?.??????? (cicatricial
pemphigoid)

• ??
• ????????
• benign mucosa membrane pemphigoid
• ?? ???????
• ??????

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1. ????
2. ?????? ???????????? ???????????

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• 5. ?? ????
• ??
• ?????
• 6. ???? ??????
• ???????
• ???????

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• 7. ??

1. ???? ???
2. ???? ???

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?.??????? (bullous pemphigoid)

• 1. ?? ???,???
• 2. ?? ??????? ??????

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• 3. ???? ???? ?? ??? ???(-)
• ????
• ????????????????
• ?? ???(-)

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???????
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???????
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4. ?? ???? ????? ???????(??????) 5.
?????? ????
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• 6. ????

?????? ?????? ?????? ????????
??
??
??
??
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• 7. ??

1. ??
2. ??? ??? ?????

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?.???????

• (?)?????????
• (lichen planus pemphigoides,LPP)
• ??????LP?BP?? ???????????

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• 1. ????
• ????????????
• ???????????? ???(-)

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• 2. ?????
• ??????? ???LP BP???
• ?????IgG?C3????,IIF???????????????
• ?????????
• ???????
• ???????
• ????????

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• 3. ??

??? ???? ????
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• (?)???????
• (paraneoplastic pemphigus, PNP)
• ??????????????????????????????????
• (?)??IgA??????
• ?????????????
• ???????????

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• Summary
• Like the skin, the oral mucosa manifests a
  variety of vesiculobullous diseases(?????). These
  vary in frequency, severity, and systemic
  consequence. The most important vesiculobullous
  diseases are pemphigus(???) and
  pemphigoid(????).

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• Pemphigus vulgaris(??????)is a serious
  chronic vesiculobullous disease of mucosa and
  skin. The disease is seen almost totally in
  adults over the age of 60 years. The specific
  cause of the disease is poorly understood.
  However, autoimmune reaction(????) is thought to
  be important in the pathogenesis of it.

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• An autoimmune mechanism is suggested by the
  finding of antibodies in the lesions of skin and
  mucasa localized in the intercellular(???) spaces
  between epithelial cells.
• The presence of antidesmosomal antibodies(?????)
  results in the dissolution of intercellular
  cementing substance (???????).
• This process results in intraepithelial(???)
  separation of the stratum germinativum (???) from
  the underlying stratum spinosum (??), with
  subsequent acantholysis (????) and loss of
  epithelial integrity.

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• Oral lesions are present in almost all cases of
  pemphigus vulgaris and often precede skin
  involvement. Any area of the mouth may be
  involved, including mucosal surfaces and
  gingivae.
• In severe cases almost the entire oral mucasa may
  be affected, with vesiculobullous lesions in
  various stages of development, regression, and
  healing.

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• The skin lesions are initially vesiculobullous
  eruptions that subsequently ulcerate and are then
  prone to secondary infection and poor healing.
• Diagnosis of the disease is based on history,
  clinical examination, cytologic smears(?????),
  biopsy, and immunofluorescent(????) techniques.

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• Although there is no cure for pemphigus vulgaris,
  the disease can usually be successfully
  controlled with immunosuppressive drugs such as
  prednisone(???).
• But these drugs may produce significant side
  effects. Local oral symptoms can be controlled
  with palliative rinses or ointment, such as
  dyclonine(????) and benzocaine(????) in orabase.

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• Pemphigoid(????) includes cicatricial pemphigoid
  and bullous pemphigoid. They are also autoimmune
  diseases. Unlike pemphigus, the antibodies are
  demonstrated in the area of the epithelial
  basement membrane.
• Consequently, subepithelial vesiculobullous
  lesion arise, in which separation is noted
  between the epithelium and the underlying
  connective tissue.

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????

• ????????
• ???????????????????
• ????????
• ??????????????,????????????
• ????
• ?????????????????????????????

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??? pemphigus
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??? pemphigus
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??? pemphigus
????()
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??? pemphigus
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?????? Pemphigus vegetans
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???? (400) acantholysis
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????(120) Intraepithelial bulla
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??????(2000) Acantholytic cell
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????(100) Subepithelial bulla
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??????? Immunofluorescence of specimen from the
lesions of pemphigus vulgaris
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???????? Immunofluorescence of specimen from the
lesions of pemphigoid
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1. ?? ?????? ???(-)
   ?????????????????? ?? ? ??
2. ? ??????????? ?????
3. ?? ????? ?? ?? ??? ???
   ???(-)
4. ?? ? ?? ?? ??? ?? ????

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???????
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• ???,??????(Nikolsky)?
• ?????????????,?????????????????,????????,????
  ??????????????????????

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• ?????
• ??? ??? ???? ????? ???? ??
• ??????
• Cushings syndrome ?? ?????? ????

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