What are immune-mediated conditions?

Immune-mediated diseases are a collection of illnesses brought on by an overreaction of the immune system due to an autoimmune or hyperinflammatory response. The oral mucosa is frequently the presenting clinical site for immune-mediated diseases.

Chronic and recurrent inflammation patterns in epithelial and connective tissue are primarily mediated by cellular and humoral-mediated immunity. Biopsy, direct and indirect immunofluorescence, immune precipitation, and immunoblotting can all be used to confirm a diagnosis. An in-depth analysis of the patient's immune status using a battery of tests and identification of any precipitating or exacerbating factors should precede the selection of therapeutic agents. A better prognosis and higher quality of life for the patient can result from a prompt and accurate diagnosis that allows for effective treatment planning. Medicines that interfere with the pathogenic mechanisms have replaced the more traditional palliative care for these diseases. Nonetheless, immunomodulatory medicines can have oral side effects, further clouding the clinical picture.

Types of immune-mediated oral conditions

Dr Jeftha treats an array of immune-mediated oral conditions, the most prevalent being:

• Oral lichen planus - Mucous membranes in the mouth can be affected by a chronic inflammatory condition called oral lichen planus. White, lacy patches, red, swollen tissues, or open sores are all possible manifestations of oral lichen planus. This irritation can range from mild to severe.
• Systemic lupus erythematosus - Most people with lupus suffer from systemic lupus erythematosus (SLE). Autoimmune diseases like SLE cause widespread inflammation and tissue damage because the body's immune system mistakenly targets healthy cells rather than foreign invaders. Oral manifestations of systemic lupus erythematosus (SLE) are common and can include oral ulceration, honeycomb plaque, raised keratotic plaque, nonspecific erythema, purpura, petechiae, and cheilitis.

• Mucous membrane pemphigoid is a collection of rare chronic autoimmune diseases, mucous membrane pemphigoid (MMP) manifests primarily as blistering lesions on the skin and mucous membranes of the mouth, nose, and lungs. One of the first places it develops is in the eyes and mouth, where the mucous membranes are. Individuals with MMP may experience different signs and symptoms depending on the affected body part and how far along the disease is. In some cases, scarring may occur after a blister heals.
• Pemphigus Vulgaris - Pemphigus affects the skin and is one of the rare autoimmune diseases. The condition causes blistering of the skin and mucous membranes all over the body. It can cause problems with the oral cavity, the respiratory system, the visual system, and the genital area. The most prevalent form of pemphigus is known as pemphigus Vulgaris. Even though pemphigus can strike at any age, it is more common in those of middle age and beyond. Some forms of the disease are fatal if left untreated, and the disease tends to be chronic. Medication is typically successful in resolving the issue.
• Erythema multiforme - An infection or certain medications can trigger a skin reaction known as erythema multiforme. It usually only lasts a few weeks and is mild. Another, the more extreme form, can be fatal and manifest in the mouth, genitalia, and eyes.
• Stevens-Johnson syndrome - Severe but rare; Stevens-Johnson syndrome (SJS) affects the skin and the mucous membranes. An adverse reaction to medication typically begins with flu-like symptoms and progresses to a painful, blistering rash. After several days, the top layer of damaged skin dies and sheds, and the body begins to repair itself.
• Epidermolysis bullosa - Scarce epidermolysis bullosa causes delicate, easily damaged skin. Blisters may form after mild trauma, such as heat, rubbing, or scratching. In extreme cases, the blisters may even form inside the body, on the mouth lining or on the stomach.

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