VESICULOBULLOUS

LESIONS
associated with
Immunological
disfunctions

Vesiculo-bullous conditions

Viral infections:
- Herpes simplex virus infection
- Varicella zoster virus infection
- Hand Foot Mouth disease
- Herpangina
- Measles

Infections associated with immunological dysfunctions:

- Pemphigus vulgaris
- Cicatricial pemphigoid

Bullous pemphigoid
}
Dermatitis herpetiformis
Erythema Multiforme
Linear IgA dermatosis

pemphigoid mucous membrane

Hereditary and acquired conditions:

- Hereditary epidermolysis bullosa
- Acquired epidermolysis bullosa

Pemphigus
vulgaris
Definition:Pemphigus is a potenttially fatal vesiculobullous disease
which has been categorized into four types: vulgaris and
vegetans. which have intra0ral manifestations and foliaceous
and erythematosus.,which are not believed to produce
oral disease.
Incidence- rare; middle- aged women, arround the Mediterranean and Ashkenazi Jews.
Aetiology- autoimmune: circulating autoantibodies to epithelial intercellular
substance

Clinical features:- oral lesions often precede skin lesions

-blisters anywhere on the mucosa( most frequently palate, gingiva & buccal
mucosa), rupture rapidly to leave ragged ulcers.
-Nikolskys sign positive (Light lateral pressure applied to a bulla will cause it to
enlarge by extension ).

Skin lesions-large flaccid blisters , especially where is trauma

Diagnosis-_Biopsy show acantholysis
- Direct Immunofluorescence
- Indirect Immunofluorescence/ELISA

Management- pemphigus is letal if not treated

-Imunnosupression with systemic corticoids plus azathioprine
-topical: clobetasol ointment in adhesive gel( 2, daily)

Red oral erosions (the mucosa is fragile and

can be easily stripped away)

Desquamative gingivitis-diffuse redness of lower

vestibular gingiva

Pemphigoid mucous membrane

Pemphigoid is a chronic self-Iimiting mucocutaneous disease that is slightly more

common in the oral cavity than pemphigus, but is associated with less morbidity
and mortality.

Incidence- not uncommun; middle- aged women or erderly females

Aetiology-autoimunne
Clinical features-Oral blisters ( sometimes blood-filled) can
present anywhere, especially at sites of trauma >ulcers, may heal with
scarring : desquamative gingivitis is common
Nikolskys sign may be positive

Others- conjunctival lesions: entropion or symblefharom

- larryngeal lesions may lead to stenosis

-skin lesions- blisters rarely
-genital lesions

Diagnosis

biopsy- subepithelial split

-imunofluorescence( C3 and IgG at basement membrane)

Management- potent topical corticosteroids, tacrolimus

- systemic corticosteroids, dapsone

Broken blisters and ulceration of the buccal

mucosa

Bullous pemphigoid, which is the least common of the two, affects both
the skin and the oral cavity and has no sexual or racial predisposition

Erythema multiforme- is a self-limiting

disease of the skin
and mucous membranes.

Erythema multiforme

Incidence-uncommon : mainly young adults males

Aetiology-reactions to microorganisms( herpes simplex,
mycoplasma), to drugs( sulphonamides or barbiturates)
- complement- mediated cytopathic effects may be involved

Clinical features- reccurent attacks, for 10-14 days, once or

twice a year, of lesions affecting mouth alone, or skin and/ or other
mucosae.
The minor form affects only one site
Oral- craked, bleeding, crusted, swollen lips and ulcers
Buccal mucosa,tongue and palate may be involved
Others- conjunctival and/or genital ulcers: rashes- typiccaly target
or iris lesions, or bullae on extremities; fever and malaise;No
lesions on trunk
Mucocutaneous lesions and systemic illness-Steven -Johnson
syndrome( the major form)-is widespread,with fever and toxicity, bullous
and other rashes, pneumonia, arthritis, nephritis or myocarditis

Diagnosis- clinical
Management-minor forms: symptomatic treatment, clobetasol , aciclovir(12g/day)

- Major forms: systemic corticosteroids ( prednisone)and/or

azathioprine