Circulating antibodies directed against the intercellular cement substance of stratified squamous epithelium are found in which disorder:_________?
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Answer: D. Pemphigus vulgari
Explanation
Pemphigus vulgaris is characterized by circulating autoantibodies directed against desmogleins within the intercellular cement substance. These antibodies disrupt cell-to-cell adhesion, causing intraepithelial blister formation within the stratified squamous epithelium. Direct immunofluorescence reveals a characteristic chicken-wire pattern of IgG deposition between epithelial cells. Pemphigus vulgaris is a severe autoimmune blistering disease affecting both skin and mucous membranes. Desmoglein 1 and desmoglein 3 serve as the primary target autoantigens for the pathogenic circulating antibodies. Tzanck smears of blister bases may demonstrate acantholytic epithelial cells lacking normal intercellular attachments.
Oral lesions often represent the initial clinical manifestation and can precede skin blistering by several months. Systemic corticosteroid therapy combined with immunosuppressive agents is mandatory to control this potentially fatal disease. Early diagnosis by an oral pathologist or dermatologist is crucial to prevent widespread painful mucosal involvement. Lichen planus is a T-cell-mediated chronic inflammatory mucocutaneous condition without these specific circulating autoantibodies. Verruca vulgaris is a benign viral papilloma caused by human papillomavirus infection rather than autoimmunity. Bullous pemphigoid involves autoantibodies directed against the basement membrane zone rather than intercellular cement.
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