vesciculobullous part 1

8/8/2019 Vesciculobullous Part 1

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Ulceration of the oral mucous membrane is a common

occurance

The word ulcer is a greek word meaning Wound or Sore It has a focus of necrotic tissue on surface & a destroyed

overlying epithelium

It consists of margin, edges , floor & base

x Margin: junction between normal epithelium & ulcer: boundary ofthe ulcer

x Edge: junction between margins & floor of ulcer.: activity is max. at

margins & edges of the ulcer


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x Floor : exposed surface of ulcer: composed of

connective tissue fibrin with polymorphonuclear

leukocyte infiltration

x Differences between base & floor : base better felt than

seen : floor exposed surface within the ulcer.


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Formation of

an ulcer


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Life cycle of an ulcer


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Differentiating between many diseases of

similar clinical appearance.Characteristic oral environment

Thin oral mucosa-causes vesciculae & bullae

to rapidly break into ulcers ulcers get easilytraumatized from teeth as well as food and

become secondarily infected

This caused the lesions having characteristic

appearance on skin to have non-specific

appearance on oral mucosa


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Detailed history: HOPI

x Length of time lesions have been present: ACUTE/CHRONIC

x The past history of similar lesions : PRIMARY/RECURRENTx No. Of lesions present: SINGLE /MULTIPLE.

Complete review of systemsx presence of skin, eye, genital & rectal lesions

x Symptoms of diseases associated with oral lesions; i.e. aboutsymptoms like joint pain, muscle weakness, dyspnea, diplopia and

chest pain Clinical examination:

Thorough inspection of exposed skin surfaces

Knowledge of basic dermatology is essential as disordersoccurring on oral mucosa may also affect the skin


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According to their clinical appearance

Macules

Papules

Plaques

Nodules

Vesicles

Bullae

Erosions Pustules

Ulcers

Purpura


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Solid raised lesions >1cm

diameter

Large papules Plaque like lichen

planus


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Well-circumscribed, flatlesions noticeable due totheir change from normalskin or mucosa colour

Red-increased

vascularity/inflammation Pigmented due to

presence ofmelanin,hemosiderin &foreign material

Ingestion ofmedication

Example in oral cavity :melanotic macule


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Solid lesions raised above

skin / mucosal surface smaller

than 1cm in diameter

Seen in wide variety ofdiseases: erythema

multiforme, rubella, lupus

erythematosus, & sarcoidosis

In oral cavity hyperplastic

candidiasis often presents as

yellow- white papules.


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Blisters containing

purulent material

Eg: Herpes virus

infection


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Present deeper in dermis

/ mucosa

May protrude above skin/ mucosa but are

generally wider than high

Oral mucosa nodule :

irritational fibroma


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Elevated blisters

containing clear fluid


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Elevated blisters

containing clear fluid >

1cm diameter

Eg: bullous pemphigoid,

epidermolysis bullosa


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Red lesions often caused

by rupture of vesicles or

bullae or trauma & are

generally moist skin

Eg: Pemphigus Vulgaris


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Well circumscribed ,

often depressed lesions

with an epithelial defect

that is covered by a fibrin

clot, causing a yellow-

white appearance

Eg: aphthous ulcer


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Reddish to purple bruises

caused by blood from vessels

leaking into the connective

tissue Do not blanch when pressure

is applied.

Classified by size:

Petechiae < 0.5 cm

Ecchymoses : larger

purpuric lesions

Eg: trauma, lupus, pemphigus


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CLASSIFICATION


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CLASSIFICATIONOF ULCERATIVE,

VESICOBULLOUS LESIONS I


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Herpes simplex virus (HSV)infection

Varicella zoster virus (VZV) infection

Cytomegalovirus (CMV) infection

Coxsackievirus (CV) infection Hand foot - & - mouth disease (HFM)

Herpangina

Lymphonodular pharyngitis

Necrotizing ulcerative gingivitis (NUG) & periodontitis (NUP)

Erythema multiforme(EM) Stevens johnson syndrome (SJS) & toxic epidermal necrolysis

(TENS)

Plasma cell stomatitis & oral hypersensitivity reactions


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Recurrent Aphthous Stomatitis (RAS)

Behcet Disease [BD (Behcet Syndrome)]


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Pemphigus Pemphigus vulgaris (PV)

Pemphigus Foliaceus

Paraneoplastic Pemphigus (PNPP)

Drug related pemphigus Pemphigus vegetans variant ofPV

Pemphigus erythematosus variant ofPemphigus Foliaceus

Subepithelial bullous dermatoses

Bullous pemphigoid (BP)

Mucous membrane pemphigoid [MMP (Cicatricial Pemphigoid)]

Linear IgA diaease (LAD)

Epidermolysis Bullosa Aquisita (EBA)

Chronic bullous disease of childhood (CBDC)


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Traumatic injuries causing solitary ulcerations

Traumatic Ulcerative Granuloma, Eosinophilic

UlcerOf Tongue

Histoplasmosis

Blastomycosis

Mucormycosis (Phycomycosis)


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CLASSIFICATIONOF ULCERS II

According to etiology & pathology


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Traumatic

Due to mechanical irritation

Chemical irritant

Thermal burns

Radiation burns

Anesthetics necrosis

Oral trauma front sexual practice


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Infection

Viral infection

Herpes simplex infection

Herpes zoster

Hand-foot and mouth disease

Herpangina

Chickenpox

Smallpox Measles

Infectious mononucleosis

AIDSHIV


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Bacterial infection

ANUG

Tuberculosis

Syphilis

Gonorrhea

Scarletfever

Diphtheria


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Fungal infection

Histoplasniosis

Blastontycosis

Mucormycosis

Cryptococcosis


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Allergy

Local (StOmatitis venenata)

Systemic

Secondary vaccinia

Acrodynia


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Neoplastic

Squamous cell carcinoma

Malignant melanoma

Non-Hodgkin's lymphoma


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Systemic disorders

Blood disorder

Agranulocytosis

Cyclic neutropenia

Leukemia

Aplastic anemia


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Nutritional deficiency

Scurvy

Riboflavin deficiency

Pellagra Protein deficiency

Malabsorption syndrome

Xerostomia

Hand-Schiiller-Christian disease

Letterer Siwe disease

Acrodermatitis enteropathica (Zinc deficiency)


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Disease of unknown etiology

Aphthous stomatitis

Erythema multiforme

Pemphigus

Bullous pemphigoid Mucous membrane pemphigoid

Erosive lichen planes

Epidermolysis bullosa

Systemic lupus erythematous Dermatitis sialometaplasia

Wagener's granulomatosis

Eosinophilic ulcer of the oral mucosa


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Syndromes

Stevens-Johnson syndrome

Behcet's syndrome

Reiter's syndrome

vesciculobullous part 1

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