Desquamative gingivitis: retrospective analysis of disease associations of a large cohort.
ABSTRACT Desquamative gingivitis (DG) is usually a manifestation of immunologically mediated mucocutaneous disorders, although it was previously suggested to be hormonally related.
One hundred and eighty-seven Caucasian UK residents with clinical features of DG (126 female, median age of 51 years, range 23-93 years) were retrospectively evaluated.
It was established that, in this population, the largest cohort yet reported, oral lichen planus was most common (70.5%) while mucous membrane pemphigoid (14%), pemphigus vulgaris (13%), linear IgA disease (1.6%), dermatomyositis (0.5%) and mixed connective tissue disease (0.5%) were less common.
Oral lichen planus is the main disorder associated with DG. However, DG may be a feature of bullous disease and connective tissue disease.
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ABSTRACT: Pemphigus vulgaris (PV) is an autoimmune disease mediated by autoantibodies against desmoglein-3 (Dsg3). It has been documented that both humoral and cellular autoimmunity play essential roles in the development of PV. Recently, we identified that T cells from PV patients respond to three antigenic fragments on the ectodomain of Dsg3. These T cells are CD4 alpha/beta cells secreting a Th2-like cytokine profile, and responding of Dsg3 in a restriction to HLA-DRBI*0402 or 1401 alleles. Other characteristics of these cells, such as detailed epitope(s) and T cell receptors (TCRs) usage, however, have not been investigated. The purpose of this study is to determine detailed T cell epitope(s) and TCR genes utilized by Dsg3-specific T cells. Here, we found that Dsg3(AA145-192)-specific cells preferentially utilize the TCRVbeta13 gene, while Dsg3(AA240-303)- and Dsg3 (AA570-614)-specific cells utilize Vbeta7 and Vbeta17 genes, respectively. Analysis of TCRValpha gene expression, it appears that Valpha22 gene is expressed by Dsg3(AA145-192)-specific cells, whereas the Valpha10 gene is predominantly utilized by Dsg3(AA240-303)-specific T cells. There are no specific utilization of Valpha gene in the group of cells proliferate to Dsg3 (AA570-614). We believe that this information will further our understanding of the properties of autoimmune T cells in patients with PV.Journal of Investigative Dermatology 01/2004; 121(6):1365-72. · 6.19 Impact Factor
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ABSTRACT: Dermatitis herpetiformis is associated with a gluten-sensitive enteropathy in >85% of cases. Both the skin lesions and the enteropathy respond to gluten restriction. Linear IgA bullous dermatosis has a much lower prevalence of histological small bowel abnormalities, and lesions are not known to respond to gluten restriction. We report a patient with linear IgA bullous dermatosis and gluten-sensitive enteropathy. This report addresses the issue of whether linear IgA bullous dermatosis can be associated with gluten-sensitive enteropathy. We evaluated the response to gluten restriction and normal diet by following the status of the patient's jejunal biopsies and skin lesions. The patient responded to gluten restriction, as shown by resolution of jejunal abnormalities and skin lesions and subsequently by recurrence of jejunal abnormalities and skin lesions with reinstitution of a gluten-containing diet. This report demonstrates that linear IgA bullous dermatosis can respond to gluten restriction if an underlying gluten-sensitive enteropathy is present.The American Journal of Gastroenterology 07/2001; 96(6):1927-9. · 7.55 Impact Factor
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ABSTRACT: To investigate the opinions, attitudes and practices towards oral cancer prevention among UK dentists as a baseline from which to measure the need for continuing education efforts in this area. Postal questionnaire survey carried out in August 1991. A questionnaire with 13 test items was piloted at continuing education courses then distributed to all subscribers of the British Dental Journal with a postage paid return envelope. The aspects inquired into were recent attempts by dentists at updating their knowledge on oral cancer, their practical approaches to screening for oral mucosal diseases and follow-up actions after oral screening, their questions to patients regarding the major risk factors for oral cancer, their efforts towards behavioural counselling for patients and any constraints felt or experienced in this regard. The questionnaire was circulated to 15,836 dentists. The response rate of 16% was poor but due to the many dentists circulated, 2519 responses were available for analysis. This large sample, though presumptively biased towards those interested in professional matters, showed an encouraging 84% claiming to perform screening of the oral mucosa routinely. Among these, 74% reported referral of screen detected cases to a hospital for further attention and only 4% would adopt a wait and see policy. Disturbingly, half of the respondents did not enquire about risk habits related to oral cancer and, among the other half who claimed to make such enquiries, only 30% routinely provided brief health education advice concerning these. Seventy-one percent agreed that giving advice against tobacco use is desirable but major constraints were identified, notably a lack of training, and frustration regarding patient compliance. There was even greater reluctance on the part of the respondents to enquire into the alcohol use of their patients and to provide advice on alcohol moderation. Most of this large but unrepresentative sample of UK dentists were carrying out screening of the oral mucosa as a part of their prevention activities in 1991. However, the survey indicated a considerable need for improvement in the manner and extent of provision of health advice in respect of the major risk factors for oral cancer: such a substantial need amongst the presumptively better motivated implies that the need amongst the practitioner population at large is even greater.Oral Diseases 02/1999; 5(1):10-4. · 2.38 Impact Factor