Stressful Life Events as a Trigger for Autoimmune Disease? A Case Report on Mucous Membrane Pemphigoid

Dental Update ◽  
2021 ◽  
Vol 48 (5) ◽  
pp. 379-382
Author(s):  
Robert Devine ◽  
Melanie Simms
Keyword(s):  
Mucous Membrane ◽  
Patient Outcomes ◽  
Stressful Life Events ◽  
Treatment Options ◽  
Rare Condition ◽  
Corticosteroid Treatment ◽  
Diagnostic Tools ◽  
Mucous Membrane Pemphigoid ◽  
Acute Presentation

This case discusses the acute presentation of a patient with mucous membrane pemphigoid to an emergency dental department. Mucous membrane pemphigoid is a rare condition, but its presentation can be severe and concerning for both the patient and clinician. The case presents the manifestations of florid desquamative gingivitis and extensive mucosal erosions due to burst bullae. We discuss the possible causes of the condition in this patient, likely to be the stress of recent cardiac surgery, as well as exploring the efficacy of diagnostic tools, treatment options and adverse effects of corticosteroid treatment. CPD/Clinical Relevance: Correct and timely diagnosis of vesiculobullous disorders has notable impacts on patient outcomes and quality of life.

scholarly journals Recent advances in managing and understanding enuresis

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1881 ◽  
Author(s):  
Charlotte Van Herzeele ◽  
Johan Vande Walle ◽  
Karlien Dhondt ◽  
Kristian Vinter Juul
Keyword(s):  
Nocturnal Enuresis ◽  
Treatment Options ◽  
Accurate Diagnosis ◽  
Diagnostic Tools ◽  
Key Factors ◽  
Circadian Variations ◽  
Her Family ◽  
Recent Advances ◽  
Urine Production

Enuresis, particularly in children during sleep, can be a debilitating condition, affecting the quality of life of the child and his or her family. The pathophysiology of nocturnal enuresis, though not clear, revolves around the inter-related mechanisms of overactive bladder, excessive nocturnal urine production, and sleep fragmentation. The first mechanism is more related to isolated nocturnal voiding, whereas the latter two are more related to nocturnal enuresis, in which circadian variations in arginine vasopressin hormone play a key role. A successful treatment would depend upon appropriately addressing the key factors precipitating nocturnal enuresis, necessitating an accurate diagnosis. Thus, advancements in diagnostic tools and treatment options play a key role in achieving overall success. This review summarizes recent advances in understanding the pathophysiology of nocturnal enuresis, diagnostic tools, and treatment options which can be explored in the future.

scholarly journals Systemic corticosteroid in the treatment of a 9-year-old boy with Oral Mucous Membrane Pemphigoid: A case report

2017 ◽  
Vol 31 (4) ◽  
pp. 186
Author(s):  
Brunno Santos de Freitas Silva ◽  
Jorge Elias Kaluf Tomeh ◽  
Claudeir Felipe De Oliveira Siqueira ◽  
Simone Sousa Silva Sant'Ana ◽  
Fernanda Paula Yamamoto-Silva
Keyword(s):  
Mucous Membrane ◽  
Systemic Corticosteroid ◽  
Mucous Membrane Pemphigoid ◽  
Low Doses ◽  
Oral Mucous Membrane ◽  
Systemic Corticosteroids ◽  
Attached Gingiva ◽  
Burning Mouth Sensation ◽  
Systemic Corticosteroid Therapy

AIM: This report is present a rare case of oral Mucous Membrane Pemphigoid (MMP) in a 9-yearold- boy successfully treated with low doses of systemic corticosteroid.CASE DESCRIPTION: A 9-year-old boy was referred to our service with the complaint of painful gingiva and generalized burning mouth sensation over 1 year. Intraoral examination revealed desquamative lesions affecting the entire attached gingiva of both the maxilla and the mandible. After the incisional biopsy the MMP diagnosis was confirmed, and the patient was initially treated with dexamethasone 0,1 mg/Ml mouth rinse twice daily for 24 weeks. Due the difficulty in eating and the presence of persistent large oral lesions, systemic prednisone 20 mg (1 mg/kg) was prescribed for 4 weeks with a 5 mg gradual reduction per week over 3 weeks. After initiating the systemic corticosteroid therapy, the patient showed total regression of the lesions, and no indication of recurrence has been observed in the past 6 months.CONCLUSION: There is no cure for MMP; however, treatment can provide complete and longlasting remission. Based on this premise, it is plausible to consider not only topical but also low doses of systemic corticosteroids in resistant cases of oral MMP, even in children. These measures could improve the quality of life of these patients by reducing pain and, consequently, improving the child’s eating behavior.

scholarly journals Oral Mucous Membrane Pemphigoid with Contact Dermatitis - A Rare Clinical Entity.

2018 ◽  
Vol 08 (03) ◽  
pp. 041-044
Author(s):  
Santhosh Shenoy ◽  
Madhurya N Kedlaya ◽  
Sajna H R. ◽  
Amitha Ramesh
Keyword(s):  
Case Report ◽  
Contact Dermatitis ◽  
Mucous Membrane ◽  
Histopathological Examination ◽  
Spontaneous Remission ◽  
Corticosteroid Treatment ◽  
Skin Lesions ◽  
Mucous Membrane Pemphigoid ◽  
History Of ◽  
Periodontal Maintenance

AbstractMucous membrane pemphigoid (MMP) is a rare inflammatory, autoimmune, subepithelial vesiculobullous lesion. Oral mucosa is affected in almost 90% of cases. Its development is chronic with a possible involvement of ocular, laryngeal and genital mucosa. Spontaneous remission is rare. Currently, improving oral hygiene, topical corticosteroid treatment is used to control the oral lesions of MMP. In the present case report, a 53 year old female patient with a known history of hypothyroidism reported to the department of Periodontology with a complaint of burning sensation and tenderness in the gums on intake of spicy food for the past one week .The patient had also noticed the formation of blisters on the gums which would break off on their own. Hence provisional diagnosis of MMP was considered based on the clinical and histopathological examination which was later confirmed with immunofluorescent interpretations. The treatment objective is to suppress extensive blister formation, to promote healing, and to prevent scarring. The above objectives were met in our case by thorough periodontal maintenance and steroid therapy. She also presented with skin lesions due to contact dermatitis caused by occupational exposure to tobacco which makes this case report unique.

Surgery for Lung Cancer and the Consequences for the Swallow

2016 ◽  
Vol 1 (13) ◽  
pp. 162-168
Author(s):  
Pippa Hales ◽  
Corinne Mossey-Gaston
Keyword(s):  
Lung Cancer ◽  
Treatment Options ◽  
Vocal Cord Palsy ◽  
Subsequent Treatment ◽  
Physiological Reserve ◽  
Palliative Phase ◽  
And Function ◽  
The Impact ◽  
Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

Gastroesophageal Reflux Disease: A Gastroenterologist's Perspective

2011 ◽  
Vol 21 (3) ◽  
pp. 89-99
Author(s):  
Michael F. Vaezi
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Best Practice ◽  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Tools ◽  
Swallowing Function ◽  
Atypical Symptoms

Gastroesophageal reflux disease (GERD) is a commonly diagnosed condition often associated with the typical symptoms of heartburn and regurgitation, although it may present with atypical symptoms such as chest pain, hoarseness, chronic cough, and asthma. In most cases, the patient's reduced quality of life drives clinical care and diagnostic testing. Because of its widespread impact on voice and swallowing function as well as its social implications, it is important that speech-language pathologists (SLPs) understand the nature of GERD and its consequences. The purpose of this article is to summarize the nature of GERD and GERD-related complications such as GERD-related peptic stricture, Barrett's esophagus and adenocarcinoma, and laryngeal manifestations of GERD from a gastroenterologist's perspective. It is critical that SLPs who work with a multidisciplinary team understand terminology, diagnostic tools, and treatment to ensure best practice.

Raynaud’s phenomenon and digital ischaemia - pharmacologic approach and alternative treatment options

VASA ◽  
2016 ◽  
Vol 45 (3) ◽  
pp. 201-212 ◽  
Author(s):  
Birgit Linnemann ◽  
Matthias Erbe
Keyword(s):  
Quality Of Life ◽  
Angiotensin Receptor Blockers ◽  
Raynaud’S Phenomenon ◽  
Treatment Options ◽  
Raynaud's Phenomenon ◽  
Tissue Loss ◽  
Receptor Antagonists ◽  
Skin Ulcers ◽  
Digital Ischaemia

Abstract. The primary goal of therapy is to reduce the frequency and intensity of Raynaud’s attacks and to minimize the related morbidity rather than to cure the underlying condition. Treatment strategies depend on whether Raynaud’s phenomenon (RP) is primary or secondary. All patients should be instructed about general measures to maintain body warmth and to avoid triggers of RP attacks. Pharmacologic intervention can be useful for patients with severe and frequent RP episodes that impair the patient’s quality of life. Calcium channel blockers are currently the most prescribed and studied medications for this purpose. There has been limited evidence for the efficacy of alpha-1-adrenergic receptor antagonists, angiotensin receptor blockers, topical nitrates or fluoxetine to treat RP. The intravenously administered prostacyclin analogue iloprost can reduce the frequency and severity of RP attacks and is considered a second-line therapy in patients with markedly impaired quality of life, critical digital ischaemia and skin ulcers who are at risk for substantial tissue loss and amputation. Phosphodiesterase inhibitors (e.g., sildenafil) can also improve RP symptoms and ulcer healing whereas endothelin-1 receptor antagonists (e.g., bosentan) are mainly considered treatment options in secondary prevention for patients with digital skin ulcers related to systemic sclerosis. However, their use in clinical practice has been limited by their high cost. Antiplatelet therapy with low-dose aspirin is recommended for all patients who suffer from secondary RP due to ischaemia caused by structural vessel damage. Anticoagulant therapy can be considered during the acute phase of digital ischaemia in patients with suspected vascular occlusive disease attributed to the occurrence of new thromboses. In patients with critical digital ischaemia, consideration should be given to hospitalisation, optimisation of medical treatment in accordance with the underlying disease and evaluation for a secondary, possibly reversible process that is causing or aggravating the clinical symptoms.

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