A Clinico Epidemiological study of Oral Manifestations in Auto Immune Skin Diseases

Vijayalakshmi, L (2020) A Clinico Epidemiological study of Oral Manifestations in Auto Immune Skin Diseases. Masters thesis, Coimbatore Medical College, Coimbatore.


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BACKGROUND: Autoimmune diseases are characterized by presence of auto antibodies that are directed against structures of the self resulting in tissue damage and degeneration. It occurs in 3-5% of the general population with female predominance. They are classified as organ-specific or multisystem. Auto immune disorder often involves oral mucosa. Oral involvement is the first and most important or often it may be the only sign of such disease process. Autoimmune skin disorder with oral involvement includes autoimmune blistering disorder and autoimmune connective tissue disorders in which autoantibodies are directed against epithelial structures and nuclear structures respectively. Autoimmune blistering disorder represents heterogenous group of dermatoses characterized by antibody mediated immune response resulting in blistering of skin and mucosae. They are broadly classified into pemphigus and pemphigoid group based on the presence of antibodies against desmosomal or hemidesmosomal adhesion proteins. In Pemphigus group of diseases, Pemphigus Vulgaris, Paraneoplastic Pemphigus usually present with mucosal involvement. In pemphigoid group of diseases, Linear IgA disease followed by Mucous Membrane Pemphigoid, Epidermolysis bullosa aquisita, Bullous pemphigoid, Dermatitis Herpetiformis and anti p200 pemphigoid may present with mucosal involvement. Autoimmune connective tissue diseases such as systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), Sjögren’s syndrome (SS) and celiac disease have an abnormality in structure or function of one or more of the elements of connective tissue. Oral mucosal lesions are erythema, erosions, ulcers rarely vesicle which are clinically similar and often non-specific. Hence, appropriate clinical examination and investigations are mandatory to arrive early diagnosis thereby reducing the morbidity and mortality associated with those diseases. JUSTIFICATION FOR THE STUDY: ➢ Early and appropriate diagnosis is important for proper treatment planning contributing to better prognosis and better quality of life of patients. ➢ Timely recognition and therapy of oral lesion is critical as it may prevent skin involvement in pemphigus vulgaris. ➢ If the treatment is instuited during the time, the disease is easier to control and the chance for an early remission is enhanced. AIMS AND OBJECTIVES: ➢ To study the epidemiological aspects like incidence, age and gender distribution of oral manifestations in auto immune skin diseases attending the OPD of Dermatology department at Coimbatore Medical College Hospital. ➢ To study the various oral manifestations, duration and distribution in auto immune skin diseases. SELECTION CRITERIA: INCLUSION CRITERIA: The selected patients will be those attending the dermatology OPD with oral manifestations in auto immune skin diseases of both sexes. EXCLUSION CRITERIA: ➢ Patients who have already been diagnosed and received treatment. ➢ Patients who refuse to give consent. METHODOLOGY: This is a cross-sectional hospital based study conducted from June 2018 to May 2019 at the outpatient Department of Dermatology, Coimbatore Medical College. Hundred patients with oral involvement who were confirmed autoimmune skin disorders based on inclusion and exclusion criteria were enrolled in this study. All the patients were explained about the study and informed written consent was obtained from them in the language of their convenience. A thorough history regarding the site, duration, precipitating factors, associated skin lesions were obtained and recorded. Demographic details such as age, gender and occupation were also documented. Complete systemic and dermatological examination were done on all participants. Baseline investigations such as complete blood count, ESR, peripheral smear, blood sugar, renal function test, liver function test, urine analysis and diagnostic procedures such as histopathological and immunofluroscence method was performed in all patients. Tzanck smear, ANA and ANA profile was carried out in selected patients. The results of the study were analysed. RESULTS: Our study included 100 patients which included 76 female and 24 male. The youngest patient among the study group was 10 years and the oldest being 78 years with an average of 49 years. Among the 100 patients, Pemphigus and its variants 46 patients, pemphigoid and its variants 18 patients, Lupus erythematosus 28 patients, systemic sclerosis 7 patients and sjogren’s syndrome 1 patient. All four disease group showed female predominance with 76 females and 24 males. The mean duration between the onset of oral lesion and skin lesion was 2-5 months. Erosion was the most common morphology. Buccal mucosa (27%) was the most common site in pemphigus whereas in pemphigoid, palate (39%) was the most common site. Erosion (74%) was the common morphology located on palate (44%) in LE patients. Microstomia (73 %) was common in SSc and sjogren’s syndrome patient had dry mouth. CONCLUSION: Oral mucosal lesions are often associated with pemphigus. They may occur before the cutaneous lesions by months.The significance of early diagnosis may help in early intervention and to reduce morbidity and mortality state.

Item Type: Thesis (Masters)
Additional Information: 201730203
Uncontrolled Keywords: Oral Manifestations, Auto Immune Skin Diseases, Clinico Epidemiological study.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 05 Feb 2021 03:08
Last Modified: 05 Feb 2021 03:08
URI: http://repository-tnmgrmu.ac.in/id/eprint/13881

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