Vous êtes sur la page 1sur 55

Lab vesiculobullous diseases

Dr. Rima Safadi

Aspirin burn

Chemical burn

Hydrogen peroxide burn

Formocresol burn

Anesthetic necrosis

Factitious ulcers

Factitious ulceration and keratosis

Factitious ulcers

SCC

RAD mucositis

Eosinophic ulcer (traumatic ulcerative granuloma)


Etiology: trauma and crush to muscles Clinical appearance Histopathologic features No relation to eosinophilic granuloma of bone treatment

Diagnosis??
Clinical Diagnosis: Recurrent aphthous stomatitis, exacerbated by orthodontic appliances

Recurrent Aphthous Stomatitis Treatment


Steroids
Topical* Systemic Intralesional

Management:
Triamcinolone acetonide 0.1% aqueous suspension, mouthrinse and expectorate QID, NPO hour after use Clobetasol 0.05% ointment, apply thin film to oral ulcers QID, NPO hour after use Use only Biotene toothpaste SLS can induce aphthous ulcers Advised to contact you in 2 weeks to report on condition

Herpetiform Aphthae

Major Aphthae

epithelium

Loss of surface epithelium

Inflammatory infiltrate

What is your differential diagnosis

Differential Diagnosis of Chronic Oral Ulcerative Lesions


Squamous cell carcinoma Deep fungal infection
Histoplasmosis, cryptococcosis, mucormycosis

Chronic viral infection


Herpes simplex, cytomegalovirus

Oral tuberculosis Trauma


Traumatic ulcerative granuloma, factiticial injury

Syphilis Major aphthous

31 YEAR OLD MAN


Chief Complaint
Oral discomfort x 1 week. Recurrences with complete remission Sometimes, entire mouth and throat, conjunctiva & skin involved.

Medical History: No abnormalities

Diagnosis?
Erythema multiformi

54 year old man Chronic gingivitis, 18 months duration

Gentle lateral pressure bu blunt instrument induced bullous formation/ Nickolsky sign

What is your differential?


What is your management?

Epithelium

Subepithelial seperation

Immunofluorescence Essential for Diagnosis


Epithelium

IgG deposition and C3

If this was your biopsy results?

Basal epithelial layer Connective tissue

DIF
epithelium

IgG and C3

Pemphigus vulgaris

Your differential?

DIF: granular deposition of IgA at BM

Diagnosis?
Dermatitis Herpetiformis

Linear deposition of IgA at basement membrane

Linear IgA Disease

If this has been going on since birth???

LIMITED MOUTH OPENING

What is your clinical diagnosis?

Epidermolysis Bullosa

If this happened in adulthood?

Epidermolysis bullosa aquista

THE END