ALLERGY AND AUTOIMMUNE DISEASES RELATED TO DENTISTRY

PRODUCED BYABDULLA ABBAS KH.

SUPERVISED BY DR.AHMED ABDULJABAR

ASPECTS OF THESE DISEASES AFFECTING ON DENTAL MANAGE: .

1 -SYSTIMIC EFFECTS AFFECTING DENTAL MANAGE.

2-IMMUNOLOGICALLY MEDIATED ORAL DISEASES.

3-RISK OF ABNORMAL RACTIONS TO DRUGS.

CAUSES: DUE TO

-EXOGENOUS ANTIGENES

-ENDOGENOUS ANTIGENES

TYPES:

1-ATOPIC DISEASES CAUSED BY EXOGENOUS AG.

2-AUTOIMMUNE DISEASES CAUSED BY ENDOGENOUS AG.

ATOPIC DISEASES:-ASTHMA-ECZEMA

-HAY FEVER-URTICARIA

-FOOD ALLERGIES-SOME DRUGS ALLERGIES

-ANAPHYLAXIS-ALLERGIC ANGIO-OEDEMA

-CONTACT DERMATITIS

ASTHMA:

THE AIM OF THIS STUDY WAS TO INVESTIGATE :

THE CARIES RISK OF ASTHMATICS IN RELATION TO 1-DENTAL PLAQUE INDICES INCREASE

2-SALIVARY FLOW RATE DECREASE3-PH AND BUFFER CAPACITY DECREASE

4-SALIVARY LEVELS OF STREPTOCOCCUS MUTANS INCREASE COMPARED WITH HEALTHY SUBJECTS

AND ALSO TO EVALUATE THESE PARAMETERS WITHIN DIFFERENT GROUPS OF ASTHMATICS ACCORDING TO THEIR MEDICATION, DURATION AND SEVERITY OF THE DISEASE.

.ASTHMA MEDICATION COMPRISES BRONCHODILATORS, CORTICOSTEROIDS AND ANTICHOLINERGIC DRUGS.

MOST OF THESE DRUGS ARE INHALED USING VARIOUS FORMS OF INHALERS OR NEBULIZERS.

THE EFFECT OF THESE DRUGS ON ORAL HEALTH IS THE SUBJECT OF DEBATE AMONG DENTAL PRACTITIONERS. PATIENTS TAKING ASTHMA MEDICATION MAY BE AT RISK OF DENTAL CARIES, DENTAL EROSION, PERIODONTAL DISEASES AND ORAL CANDIDIASIS .

HENCE, PATIENTS WITH BRONCHIAL ASTHMA ON MEDICATION SHOULD RECEIVE SPECIAL PROPHYLACTIC ATTENTION.

ECZEMA SYMPTOMS INCLUDE:

ITCHY, RED, AND DRY SKIN CAUSED BY INFLAMMATION .

IT’S MOST COMMONLY FOUND IN CHILDREN, ALTHOUGH ADULTS CAN GET IT. IT IS ALSO CALLED ATOPIC DERMATITIS

-AND IS TREATED WITH ORAL MEDICATIONS, STEROID CREAMS AND LIGHT THERAPY.

HAY FEVER (ALLERGIC RHINITIS)

IS A COMMON CONDITION THAT SHOWS SIGNS AND SYMPTOMS SIMILAR TO A COLD WITH SNEEZING, CONGESTION, RUNNY NOSE AND SINUS PRESSURES.

-HAY FEVER IS CAUSED BY AN ALLERGIC RESPONSE TO AIRBORNE SUBSTANCES, SUCH AS POLLEN - UNLIKE A COLD WHICH IS CAUSED BY A VIRUS. THE TIME OF YEAR IN WHICH YOU GET HAY FEVER DEPENDS ON WHAT AIRBORNE SUBSTANCE YOU ARE ALLERGIC TO.

URTICARIAIS A KIND OF SKIN RASH NOTABLE FOR PALE RED, RAISED, ITCHY BUMPS.MAY CAUSE A BURNING OR STINGING SENSATION.

 THEY ARE FREQUENTLY CAUSED BY ALLERGIC REACTIONS; HOWEVER, THERE ARE MANY NONALLERGIC CAUSES .

MOST CASES OF HIVES LASTING LESS THAN SIX WEEKS (ACUTE URTICARIA) ARE THE RESULT OF AN ALLERGIC TRIGGER. CHRONIC URTICARIA (HIVES LASTING LONGER THAN SIX WEEKS) IS RARELY DUE TO AN ALLERGY.

THE MAJORITY OF CHRONIC HIVES CASES HAVE AN UNKNOWN (IDIOPATHIC) CAUSE. IN PERHAPS AS MANY AS 30–40% OF PATIENTS WITH CHRONIC IDIOPATHIC URTICARIA, IT IS CAUSED BY AN AUTOIMMUNE REACTION.

A FOOD ALLERGY IS AN ABNORMAL IMMUNE RESPONSE TO FOOD .

THE SIGNS AND SYMPTOMS MAY RANGE FROM MILD TO SEVERE .THEY MAY INCLUDE ITCHINESS, SWELLING OF THE TONGUE, VOMITING, DIARRHEA, HIVES, TROUBLE BREATHING, OR LOW BLOOD PRESSURE. THIS TYPICALLY OCCURS WITHIN MINUTES TO SEVERAL HOURS OF EXPOSURE. WHEN THE SYMPTOMS ARE SEVERE IT IS KNOWN ASANAPHYLAXIS..

HISTORICALLY, PENICILLIN AND OTHER SIMILAR ANTIBIOTICS ARE THE DRUGS MOST PEOPLE ARE ALLERGIC TO.OTHER DRUGS COMMONLY FOUND TO CAUSE ALLERGIC REACTIONS INCLUDE SULFA DRUGS, BARBITURATES, ANTICONVULSANTS, AND INSULIN.

THE IMMUNE SYSTEM RECOGNIZES THE DRUG AS A FOREIGN SUBSTANCE AND THE BODY PRODUCES CERTAIN CHEMICALS, SUCH AS LARGE AMOUNTS OFHISTAMINEWHAT ARE THE SYMPTOMS OF A DRUG ALLERGY?

SYMPTOMS OF A DRUG ALLERGY CAN RANGE FROM MILD TO LIFE-THREATENING. EVEN IN PEOPLE WHO AREN'T ALLERGIC, MANY DRUGS CAN CAUSE INTOLERANCE AND IRRITATION, SUCH AS AN UPSET STOMACH. BUT DURING AN ALLERGIC REACTION, THE RELEASE OF HISTAMINE CAN CAUSE SYMPTOMS LIKE HIVES, SKIN RASH, ITCHY SKIN OR EYES, CONGESTION, AND SWELLING IN THE MOUTH AND THROAT.A MORE SEVERE REACTION, CALLED ANAPHYLAXIS, MAY INCLUDE DIFFICULTY BREATHING, BLUENESS OF THE SKIN, DIZZINESS, FAINTING, ANXIETY, CONFUSION, RAPID PULSE, NAUSEA, DIARRHEA, AND ABDOMINAL PROBLEMS.

DRUGS ALLERGIES

ANAPHYLAXIS IS A SERIOUS ALLERGIC REACTION THAT IS RAPID IN ONSET AND MAY CAUSE DEATH.

IT TYPICALLY CAUSES A NUMBER OF SYMPTOMS INCLUDING AN ITCHY RASH, THROAT SWELLING, AND LOW BLOOD PRESSURE. COMMON CAUSES INCLUDE INSECT BITES AND STINGS, FOODS, AND MEDICATIONS.

ON A MECHANISTIC LEVEL, ANAPHYLAXIS IS CAUSED BY THE RELEASE OF MEDIATORS FROM CERTAIN TYPES OF WHITE BLOOD CELLSTRIGGERED BY EITHER IMMUNOLOGIC OR NON-IMMUNOLOGIC MECHANISMS. CLINICIANS DIAGNOSE THE CONDITION ON THE BASIS OF THE PRESENTING SYMPTOMS AND SIGNS .

THE PRIMARY TREATMENT IS INJECTION OF EPINEPHRINE, THE ADMINISTRATION OF INTRAVENOUS FLUIDS, AND POSITIONING THE PERSON FLAT, WITH OTHER MEASURES BEING COMPLEMENTARY.

SYMPTOMS TYPICALLY INCLUDE GENERALIZED HIVES,ITCHINESS, FLUSHING, OR SWELLING (ANGIOEDEMA) OF THE AFFICTED TISSUES.

THOSE WITH ANGIOEDEMA MAY DESCRIBE A BURNING SENSATION OF THE SKIN RATHER THAN ITCHINESS.  SWELLING OF THE TONGUE OR THROAT OCCURS IN UP TO ABOUT 20% OF CASES.

OTHER FEATURES MAY INCLUDE A RUNNY NOSE AND SWELLING OF THE CONJUNCTIVA.THE SKIN MAY ALSO BE BLUE TINGED BECAUSE OF  LACK OF OXYGEN.

IN SEVERE CAUSES IM EPI. GIVEN IMMEDIATILLY IF AIRWAY THREATENED BY ATTACKS OF ANGIO-OEDEMA.

ANGIO-OEDEMA

CONTACT DERMATITISIT IS REASEMBLE TO ECZEMA CLINICALLY BUT IT IS MEDIATED BY

TYPE 4 REACTION.IN DENTISTRY IT IS CAUSED BY SOME DENTAL MATERALS MAINLY LATEX ,AMALGAM AND SOME IMPRESSION MATERIALS ETC..

-LATEX ALLERGY : PERIORAL RASH AND IN RARE CASES CAN BE SVRE AND ANAPHYLACTOID I CHARACTER AND HAVE BE FATAL.

-MERCURY ALLERGY: LOCALLY(CONTACT DERMATITS) OR SYSTMIC DUE TO ABSORBTION OF MERCURY COMPOUNDS SUCH AS METHYL MERCURY THAT HAVE NEUROTOXIC EFFEECT

THE AUTOIMMUNE DISASESTYPICAL FEATURES :

-COMMON IN WOMEN-ONSET IN MID. AGES

+-FAMILY HISORY-AB LEVEL USUALLY RAISED

-CERCULATING AB FREQ. DETECTABLE IN UNEFFECTED FAMILY MMEBERS

-CERCULATING AB TO SEVERAL TISSUES BUT NOT ALL ATTACKED

-INCREASE RISK OF DEVELOPING OF OTHER AUTOIMMUNE DISEASES

-AB AD COMPLEMENTOFEN DETECTABLE AT SITE OF TISSUE DAMAGE

-IMMUNESUPPRESSIVE TREATMENT LIMIT THE TISSUE DAMAGE

THE AUTOIMMUNE DISASES

1-CONNECTIVE TISSUE DISEASES.

2-AUTIMMUNE DISEASES WITH SPESIFIC AUTOANTIBODIES.

CONNECTIVE TISSUE DISEASESRHEUMATOID ARTHRITIS

-THE TMJ INVOLVED IN MOST SEVERE CASES-DRUGS USED IN RHEUMATOID

ARTHRITIS(ASPIRIN,NSAIDS,CORTICOSTEROIDS,ANTIMALARIAL,GOLDS AND PENCILLAMINE) AFFECT DENTAL MANAGE. OR CAUSE ORAL REACTIONS.

-MANY PT. ARE ANAEMIC DUE TO GASTRIC BLOOD LOSS INDUCED BY ANALGESECS

SJOGRENS SYNDROMES-MID. AGES

-RH. ARTHRITIS ASSOCIATED WITH SECONDARY PHASE.-DRY MOUTH

-DRY EYE-S.G INFILTRATED BY CD4 LYMPHOCYTES AND ACINAR DISTRUCTION

-RISK OF S.G. AND EXTRASALIVARY LYMPHOMAS

ORAL MANIFESTATIONS-DISCOMFORT

-DIFFICULTIES IN EATING AND SWALLOWING

-DISTRUBED TASTE SENSATION-DISTRUBED QUALITY OF SPEECH

-PREDISPOSITION OF INFECTION-WITH NON COMMON PAROTIDS

SWELLINGS

MANAGMENT

-GIVE REASSURANCE AND HELP DRY MOUTH

-CONTROL CARIES-MONITOR MUCOUSAL

CANDIDOSIS-TREAT DIFFICULTIES WITH

DENTURES SYMPTOMATICALLY-OBSERVE REGULARY FOR

POSSIBLE DEVELOPMENT OF ASCENDING PAROTITIS OR LYMPHOMA

LUPUS ERYTHEMATOSUS

-SYSTIMIC LUPUS ERYTHEMATOSUS

-DISCOIDLUPUS ERYTHEMATOSUS

SLE-JOINT:PAIN AND ARTHRITIS

-SKIN: RASH(BUTTERFLY RASH ACROSS MID FACE)

-MOUTH: STOMATITIS AND SJOGREN S.SEROUS MEM. : PERICARDITIS

-HEART : ENDOCARDITS AND MYOCARDITIS

-LUNG : PNEUNONITIS-KIDNEYS : NEPHRITIS S.

-CNS : NEUROSIS,STROK AND CN PALSIES

-EYES . CONJUNCVTIVITIS AND RETAINAL DAMAGEGIT: HEPATOMEGALY AND PANCREATITIS

-BLOOD : ANAEMIA AND PURPURA

EFFECTION ON DENTAL MANAGEMENT

-CORTICOSTEROID AND OTHER IMMUNOSUPPRESSIVE DRUGS

-PAINFUL ORAL LESIONS-SJOGREN S.

-BLEEDING TENDENCIES-ANAEMIA

-CARDIAC DISEASE AND RISK OF ENDOCARDITIS

DLE

SIMILAR TO SLE BUT WITHOUT LATTERS SEROLOGICAL CHANGES AND SYSTEMIC DISORDERS.

SYSTEMIC SCLEROSIS(SCLERODERMA)

-SJOGREN SS.-LIMITED ORAL OPENING

-WIDENING IN PDL SHADOW-GROSS RESORPTION OF JAW

-FIRM WHITISH-YELLOW FIBROTIC MUCOUSAL PLAQUE

-STIFNESS OF SKIN ,GIT,HEART,LUNGS AND KIDNEY

-FACIAL FEATURES BECOME SMOOTH (MASK LIKE)

-RAYNAUDS PHNOMENON.

PERNICIOUS ANEMIA UNTREATED PERNICIOUS ANEMIA CAN LEAD TO:

-NEUROLOGICAL COMPLICATIONS, AND IN SERIOUS CASES, DEATH. HOWEVER, IN 20% OF CASES OF COBALAMIN DEFICIENCY, ANEMIA IS NOT OBSERVED.  WHILE IT MAY CONSIST OF THE TRIAD OF PARESTHESIAS, SORE TONGUE, AND WEAKNESS, THIS IS NOT THE CHIEF SYMPTOM COMPLEX.  COMMON SYMPTOMS INCLUDE ANEMIA,  FATIGUE,  DEPRESSION,  LOW-GRADE FEVERS, DIARRHEA,DYSPEPSIA,  WEIGHT LOSS, NEUROPATHIC PAIN, JAUNDICE, GLOSSITIS (SWOLLEN, RED AND SMOOTH APPEARANCE OF THE TONGUE), ANGULAR CHEILITIS (SORES AT THE CORNER OF THE MOUTH), DEHYDRATED/CRACKED AND PALE LIPS AND DARK CIRCLES AROUND THE EYES (LOOK OF EXHAUSTION),  BRITTLE NAILS, AND THINNING AND EARLY GREYING OF THE HAIR. BECAUSE PA MAY AFFECT THE NERVOUS SYSTEM, SYMPTOMS MAY ALSO INCLUDE DIFFICULTY INPROPRIOCEPTION, MEMORY CHANGES,  MILD COGNITIVE IMPAIRMENT (INCLUDING DIFFICULTY CONCENTRATING AND SLUGGISH RESPONSES, PSYCHOSIS, IMPAIRED URINATION, LOSS OF SENSATION IN THE FEET, UNSTEADY GAIT, DIFFICULTY IN WALKING, MUSCLE WEAKNESS AND CLUMSINESS ANEMIA MAY CAUSE TACHYCARDIA (RAPID HEARTBEAT)  AND CARDIAC MURMURS, ALONG WITH A YELLOW WAXY PALLOR, LOW BLOOD PRESSURE, 

HIGH BLOOD PRESSURE, AND  SHORTNESS OF BREATH .

IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP)ALSO KNOWN AS PRIMARY IMMUNE THROMBOCYTOPENIA, PRIMARY IMMUNE THROMBOCYTOPENIC PURPURA OR AUTOIMMUNE THROMBOCYTOPENIC PURPURA

IS DEFINED AS ISOLATED LOW PLATELET COUNT (THROMBOCYTOPENIA) WITH NORMAL BONE MARROW AND THE ABSENCE OF OTHER CAUSES OF THROMBOCYTOPENIA. IT CAUSES A CHARACTERISTIC PURPURIC RASH AND AN INCREASED TENDENCY TO BLEED .

TWO DISTINCT CLINICAL SYNDROMES MANIFEST AS AN ACUTE CONDITION IN CHILDREN AND A CHRONIC CONDITION IN ADULTS. THE ACUTE FORM OFTEN FOLLOWS AN INFECTION AND HAS A SPONTANEOUS RESOLUTION WITHIN 2 MONTHS. CHRONIC IDIOPATHIC THROMBOCYTOPENIC PURPURA PERSISTS LONGER THAN 6 MONTHS WITH A SPECIFIC CAUSE BEING UNKNOWN.ITP IS AN AUTOIMMUNE DISEASE WITH ANTIBODIES DETECTABLE AGAINST SEVERAL PLATELET

SURFACE ANTIGENS.ITP IS DIAGNOSED BY A LOW PLATELET COUNT IN A COMPLETE BLOOD COUNT (A COMMON BLOOD TEST). HOWEVER, SINCE THE DIAGNOSIS DEPENDS ON THE EXCLUSION OF OTHER CAUSES OF A LOW PLATELET COUNT, ADDITIONAL INVESTIGATIONS (SUCH AS A BONE MARROW BIOPSY) MAY BE NECESSARY IN SOME CASES.IN MILD CASES, ONLY CAREFUL OBSERVATION MAY BE REQUIRED BUT VERY LOW COUNTS OR SIGNIFICANT BLEEDING MAY PROMPT TREATMENT WITH CORTICOSTEROIDS, INTRAVENOUS IMMUNOGLOBULIN, ANTI-D IMMUNOGLOBULIN, OR IMMUNOSUPPRESSIVE DRUGS.REFRACTORY ITP (NOT RESPONSIVE TO CONVENTIONAL TREATMENT) MAY REQUIRE SPLEENECTOMY, THE SURGICAL REMOVAL OF THE SPLEEN.PLATELET TRANSFUSIONS MAY BE USED IN SEVERE BLEEDING TOGETHER WITH A VERY LOW COUNT. SOMETIMES THE BODY MAY COMPENSATE BY MAKING ABNORMALLY LARGE PLATELETS.

SIGNS INCLUDE-THE SPONTANEOUS FORMATION OF BRUISES (PURPURA) AND PETECHIAE (TINY

BRUISES), ESPECIALLY ON THE EXTREMITIES,BLEEDING FROM THE NOSTRILS AND/OR GUMS

 -MENORRHAGIA( EXCESSIVE  MENSTRUAL BLEEDING ,)ANY OF WHICH MAY OCCUR IF THE PLATELET COUNT IS BELOW 20,000 PER ΜL

-A VERY LOW COUNT (<10,000 PER ΜL) MAY RESULT IN THE SPONTANEOUS FORMATION OFHEMATOMAS (BLOOD MASSES) IN THE MOUTH OR ON OTHER MUCOUS MEMBRANES. BLEEDING TIME FROM MINOR LACERATIONS ORABRASIONS IS USUALLY PROLONGED.

-SERIOUS AND POSSIBLY FATAL COMPLICATIONS DUE TO EXTREMELY LOW COUNTS (<5,000 PER ΜL) INCLUDE SUBARACHNOID OR INTRACEREBRAL HEMORRHAGE (BLEEDING INSIDE THE SKULL OR BRAIN), LOWER GASTROINTESTINAL BLEEDING OR OTHER INTERNAL BLEEDING .

SOME MEDICATIONS CAN HAVE AN IMPACT ON THE NUMBER AND FUNCTION OF WHITE BLOOD CELLS.

1 -CLOZAPINE ,AN ANTIPSYCHOTIC MEDICATION WITH A RARE ADVERSE EFFECT LEADING TO THE TOTAL ABSENCE OF ALL GRANULOCYTES (NEUTROPHILS, BASOPHILS, EOSINOPHILS) .

2-THE ANTIDEPRESSANT AND SMOKING ADDICTION TREATMENT DRUG BUPROPION HCL (WELLBUTRIN) CAN ALSO CAUSE LEUKOPENIA WITH LONG-TERM USE .

3- MINOCYCLINE ,A COMMONLY PRESCRIBED ANTIBIOTIC, IS ANOTHER DRUG KNOWN TO CAUSE LEUKOPENIA.

4-THERE ARE ALSO REPORTS OF LEUKOPENIA CAUSED BY DIVALPROEX SODIUM OR VALPROIC ACID (DEPAKOTE), A DRUG USED FOR EPILEPSY (SEIZURES) AND MIGRAINE.

5-THE ANTICONVULSANT DRUG, LAMOTRIGINE, HAS BEEN ASSOCIATED WITH A DECREASE IN WHITE BLOOD CELL COUNT.

6-OTHER MEDICATIONS INCLUDE IMMUNOSUPPRESSIVE DRUGS, SUCH AS SIROLIMUS, MYCOPHENOLATE MOFETIL, TACROLIMUS, CYCLOSPORINE, LEFLUNOMIDE (ARAVA) AND 

TNF INHIBITORS.7- INTERFERONS USED TO TREAT MULTIPLE SCLEROSIS, SUCH AS REBIF, AVONEX, AND 

BETASERON ,

DRUGS ASSOCIATED LEUCOPENIA

ADDISON’S DISEASE  CHRONIC ADRENAL INSUFFICIENCY, HYPOCORTISOLISM, ANDHYPOADRENALISM

IS A RARE, CHRONIC ENDOCRINE SYSTEM DISORDER IN WHICH THE ADRENAL GLANDS DO NOT PRODUCE SUFFICIENTSTEROID HORMONES (GLUCOCORTICOIDS AND MINERALOCORTICOIDS). IT IS CHARACTERISED BY A NUMBER OF RELATIVELY NONSPECIFIC SYMPTOMS, SUCH AS ABDOMINAL PAIN AND WEAKNESS, BUT UNDER CERTAIN CIRCUMSTANCES, THESE MAY PROGRESS TO ADDISONIAN CRISIS, A SEVERE ILLNESS WHICH MAY INCLUDE VERY LOW BLOOD PRESSURE AND COMA. AN ADRENAL CRISIS OFTEN OCCURS IF THE BODY IS SUBJECTED TO STRESS, SUCH AS AN ACCIDENT, INJURY, SURGERY, SEVERE INFECTION OR ILLNESS; DEATH MAY QUICKLY FOLLOW.

THE CONDITION ARISES FROM PROBLEMS WITH THE ADRENAL GLAND, PRIMARY ADRENAL INSUFFICIENCY, AND CAN BE CAUSED BY ' DAMAGE BY THE BODY S OWN IMMUNE SYSTEM ,

ADDISON'S DISEASE AND OTHER FORMS OF HYPOADRENALISM ARE GENERALLY DIAGNOSED VIA BLOOD TESTS AND  MEDICAL IMAGING.

TREATMENT INVOLVES REPLACING THE ABSENT HORMONES (ORAL HYDROCORTISONE AND FLUDROCORTISONE).[2] LIFELONG, CONTINUOUS STEROID REPLACEMENT THERAPY IS REQUIRED, WITH REGULAR FOLLOW-UP TREATMENT AND MONITORING FOR OTHER HEALTH PROBLEMS.

HYPOTHYROIDISMIS A COMMONDISORDER OF THE ENDOCRINE SYSTEM IN WHICH THE THYROID GLAND DOES NOT PRODUCE ENOUGH 

THYROID HORMONE .

-WORLDWIDE, TOO LITTLE IODINE IN THE DIET IS THE MOST COMMON CAUSE OF HYPOTHYROIDISM.[1][2] IN COUNTRIES WITH ENOUGH IODINE IN THE DIET, THE MOST COMMON CAUSE OF HYPOTHYROIDISM IS THE AUTOIMMUNE CONDITION HASHIMOTO'S THYROIDITIS. LESS COMMON CAUSES INCLUDE THE FOLLOWING: PREVIOUS TREATMENT WITH RADIOACTIVE IODINE, INJURY TO THE HYPOTHALAMUS OR THEANTERIOR PITUITARY GLAND, CERTAIN MEDICATIONS, A LACK OF A FUNCTIONING THYROID AT BIRTH, OR PREVIOUS 

THYROID SURGERY. -THE DIAGNOSIS OF HYPOTHYROIDISM, WHEN SUSPECTED,

CAN BE CONFIRMED WITH BLOOD TESTS MEASURING THYROID-STIMULATING HORMONE (TSH) AND THYROXINE LEVELS.HYPOTHYROIDISM CAN BE TREATED WITH MANUFACTURED LEVOTHYROXINE MEDICATIONS SUCH AS BETA BLOCKERS MAY CONTROL THE SYMPTOMS AND 

ANTI-THYROID MEDICATIONS SUCH AS METHIMAZOLE

HYPERTHYROIDISM IS THE CONDITION THAT OCCURS DUE TO EXCESSIVE PRODUCTION OF THYROID HORMONE

 BY THE  THYROID GLAND -CAUSES INCLUDE MULTINODULAR GOITER, 

TOXIC ADENOMA, INFLAMMATION OF THE THYROID, EATING TOO MUCH IODINE, AND TOO MUCH SYNTHETIC THYROID HORMONE.  A LESS COMMON

CAUSE IS A  PITUITARY ADENOMA .-TREATMENT DEPENDS PARTLY ON THE CAUSE AND

SEVERITY OF DISEASE. THERE ARE THREE MAIN TREATMENT OPTIONS: RADIOIODINE THERAPY, MEDICATIONS, AND THYROID SURGERY.  MAY TEMPORARILY HELP PEOPLE WHILE OTHER TREATMENTS ARE HAVING EFFECT. SURGERY TO REMOVE THE THYROID IS ANOTHER OPTION .

HYPOPARATHYROIDISM IS DECREASED FUNCTION OF THE 

PARATHYROID GLANDS WITH UNDERPRODUCTION OF PARATHYROID HORMONE. THIS CAN LEAD TO LOW LEVELS OF CALCIUM IN THE BLOOD, OFTEN CAUSING CRAMPING AND TWITCHING OF MUSCLES OR TETANY(INVOLUNTARY MUSCLE CONTRACTION), AND SEVERAL OTHER SYMPTOMS. THE CONDITION CAN BE INHERITED, BUT IT IS ALSO ENCOUNTERED AFTER THYROID OR PARATHYROID GLAND SURGERY, AND IT CAN BE CAUSED BY IMMUNE SYSTEM-RELATED DAMAGE AS WELL AS A NUMBER OF RARER CAUSES .

-THE DIAGNOSIS IS MADE WITH  BLOOD TESTS -THE TREATMENT OF HYPOPARATHYROIDISM IS

LIMITED BY THE FACT THAT THERE IS NO ARTIFICIAL FORM OF THE HORMONE THAT CAN BE ADMINISTERED AS REPLACEMENT; CALCIUM REPLACEMENT OR VITAMIN D CAN AMELIORATE THE SYMPTOMS BUT CAN INCREASE THE RISK OF 

KIDNEY STONES AND  CHRONIC KIDNEY DISEASE.

PEMPHIGUS VULGARIS IS A CHRONIC BLISTERING SKIN DISEASE WITH 

SKIN LESIONS THAT ARE RARELY PRURITIC, BUT WHICH ARE OFTEN PAINFUL IT IS CLASSIFIED AS A TYPE II HYPERSENSITIVITY REACTION, WITH THE FORMATION OF ANTI-DESMOSOME ANTIBODIES.

-THE PATHOGENESIS OF THE DISEASE INVOLVES AUTOANTIBODIES AGAINST DESMOSOME PROTEINS, SEPARATING KERATINOCYTES FROM THE BASAL LAYER OF THE EPIDERMIS. ON HISTOLOGY, THE BASAL KERATINOCYTES ARE USUALLY STILL

ATTACHED TO THE  BASEMENT MEMBRANE 

TRANSUDATIVE FLUID ACCUMULATES IN BETWEEN THE KERATINOCYTES AND BASEMENT MEMBRANE (SUPRABASAL SPLIT), FORMING A BLISTER AND RESULTING IN WHAT IS KNOWN AS A POSITIVE 

' NIKOLSKY S SIGN

MUCOUS MEMBRANE PEMPHIGOIDIS A RARE CHRONIC AUTOIMMUNE SUBEPITHELIAL BLISTERING DISEASE CHARACTERIZED BY EROSIVE SKIN LESIONS OF THE MUCOUS MEMBRANES AND SKIN THAT RESULTS IN SCARRING OF AT LEAST SOME SITES OF INVOLVEMENT.

-CICATRICIAL PEMPHIGOID HAS BEEN REFERRED TO BY A VARIETY OF DESIGNATIONS BASED LARGELY ON ITS SITE OF INVOLVEMENTS, WITH EXAMPLES OF SUCH TERMINOLOGY INCLUDING "DESQUAMATIVE GINGIVITIS," "OCULAR PEMPHIGUS" AND "BENIGN MUCOUS MEMBRANE PEMPHIGOID

ERYTHEMA MULTIFORME IS A SKIN CONDITION OF UNKNOWN CAUSE, POSSIBLY MEDIATED BY DEPOSITION OF IMMUNE COMPLEX(MOSTLY IGM) IN THE SUPERFICIAL MICROVASCULATURE OF THE SKIN AND ORAL MUCOUS MEMBRANE THAT USUALLY FOLLOWS AN INFECTION OR DRUG EXPOSURE. IT IS AN UNCOMMON DISORDER, WITH PEAK INCIDENCE IN THE SECOND AND THIRD DECADES OF LIFE.

-THE CONDITION VARIES FROM A MILD, SELF-LIMITED RASH (E. MULTIFORME MINOR) TO A SEVERE, LIFE-THREATENING FORM KNOWN AS ERYTHEMA MULTIFORME MAJOR THAT ALSO INVOLVES MUCOUS MEMBRANES.THE MILD FORM USUALLY PRESENTS WITH MILDLY ITCHY (BUT ITCHING CAN BE VERY SEVERE), PINK-RED BLOTCHES, SYMMETRICALLY ARRANGED AND STARTING ON THE EXTREMITIES. IT OFTEN TAKES ON THE CLASSICAL "TARGET LESION" APPEARANCE,

 WITH A PINK-RED RING AROUND A PALE CENTER. RESOLUTION WITHIN 7–10 DAYS IS THE NORM.

CAUSE OF EM:-INFECTIONS :

BACTERIAL: HAEMOLYTIC  STREPTOCOCCI, LEGIONELLOSIS, LEPROSY, NEISSERIA MENINGITIDIS,MYCOBACTERIUM, PNEUMOCOCCUS, SALMONELLA SPECIES, STAPHYLOCOCCUS SPECIES ,

MYCOPLASMA PNEUMONIAE,) CHLAMYDIAL.FUNGAL( COCCIDIOIDES IMMITIS)

PARASITIC (TRICHOMONAS SPECIES, TOXOPLASMA GONDII),VIRAL (ESPECIALLY HERPES SIMPLEX)

-DRUGS REACTION: MOST COMMONLY TO: ANTIBIOTICS (INCLUDING, SULPHONAMIDES, PENICILLIN), ANTICONVULSANTS (PHENYTOIN, BARBITURATES), ASPIRIN, ANTITUBERCULOIDS, AND ALLOPURINOL AND MANY OTHERS.

-PHYSICAL FACTORS: RADIOTHERAPY, COLD, SUNLIGHTOTHERS: COLLAGEN DISEASES, VASCULITIDES ,- NON HODGKIN LYMPHOMA ,LEUKAEMIA ,

MULTIPLE MYELOMA , MYELOID METAPLASIA ,POLYCYTHEMIA