autoimmune vesiculo bullous lesions

7/25/2019 Autoimmune Vesiculo Bullous Lesions

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VESICULOBULLOUSLESIONS

associated withImmunological

disfunctions


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Vesiculo-bullous conditionsiral infections:

Herpes simplex virus infectionVaricella zoster virus infectionHand Foot Mouth diseaseHerpangina Measles

nfections associated with immunological dysfunctions:Pemphigus vulgarisCicatricial pemphigoid

ullous pemphigoid ! pemphigoid mucous memrane"ermatitis herpetiformis#r$thema Multiforme %inear Ig& dermatosis

ereditary and ac"uired conditions:Hereditar$ epidermol$sis bullosa

&c'uired epidermol$sis bullosa


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$ulgaris%e&nition:Pemphigus is a potenttiall$ fatal vesiculobullous disease

(hich has been categorized into four t$pes) $ulgaris and$egetans* (hich have intra+ral manifestations and foliaceous

and erythematosus',(hich are not believed to produce

oral disease*

Incidence- rare middle- aged (omen, arround the Mediterranean and &sh.enazi /e(s*

(etiology) autoimmune: circulating autoantibodies to epithelial intercellularsubstance

Clinical features:) oral lesions often precede s.in lesions

-blisters an$(here on the mucosa0 most fre'uentl$ palate, gingiva 1 buccalmucosa2, rupture rapidl$ to leave ragged ulcers*

-3i.ols.$4s sign positive 0%ight lateral pressure applied to a bulla (ill cause it to

enlarge b$ extension 2*

S*in lesions-large 5accid blisters , especiall$ (here is trauma%iagnosis)+Biopsy , sho( acanthol$sis - "irect Immuno5uorescence

- Indirect Immuno5uorescence6#%I7&

-anagement) pemphigus is letal if not treated

-Imunnosupression (ith s$stemic corticoids plus azathioprine

-topical) clobetasol ointment in adhesive gel0 8, dail$2


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9ed oral erosions 0the mucosa is fragile andcan be easil$ stripped a(a$2


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"es'uamative gingivitis-di:use redness of lo(ervestibular gingiva


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Pemphigoid mucous membrane Pemphigoid is a chronic self-Iimiting mucocutaneous disease that is slightl$ more

common in the oral cavit$ than pemphigus, but is associated (ith less morbidit$

and mortalit$*

Incidence-not uncommun middle- aged (omen or erderl$ females

(etiology)autoimunneClinical features)Oral blisters 0 sometimes blood-;lled2 can

present an$(here, especiall$ at sites of trauma


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ro.en blisters and ulceration of the buccalmucosa


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Bullous pemphigoid, (hich is the least common of the t(o, a:ects both

the s.in and the oral cavit$ and has no sexual or racial predisposition*


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Erythema multiforme)is a self-limitingdisease of the s.inand mucous membranes*


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#r$thema multiformeIncidence)uncommon ) mainl$ $oung adults males

(etiology)reactions to microorganisms0 herpes simplex,m$coplasma2, to drugs0 sulphonamides or barbiturates2

- complement- mediated c$topathic e:ects ma$ be involved

Clinical features) reccurent attac.s, for @+-@A da$s, once ort(ice a $ear, of lesions a:ecting mouth alone, or s.in and6 or othermucosae*

Bhe minor form a:ects onl$ one site

Oral) cra.ed, bleeding, crusted, s(ollen lips and ulcersuccal mucosa,tongue and palate ma$ be involved

Others) con=unctival and6or genital ulcers) rashes- t$piccal$ target4or iris4 lesions, or bullae on extremities fever and malaise3olesions on trun.

-ucocutaneous lesions and systemic illness)Ste$en).ohnsonsyndrome/ the ma=or form0)is (idespread,(ith fever and toxicit$, bullousand other rashes, pneumonia, arthritis, nephritis or m$ocarditis

%iagnosis) clinical-anagement)minor forms) s$mptomatic treatment, clobetasol , aciclovir0@-

8g6da$2

- Ma=or forms) s$stemic corticosteroids 0 prednisone2and6orazathioprine


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autoimmune vesiculo bullous lesions

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