Ulcerative, Vesicular, and Bullous Lesions PDF

ULCERATIVE, VESICULAR, AND BULLOUS LESIONS PRESENTED BY :AMIRA ABDELWHAB LECTURER OF ORAL MEDICINE  ACUTE MULTIPLE ULCERS Herpes Simplex Virus Infections Varicella-Zoster Virus Infections RECURRING ORAL ULCERS Cytomegalovirus Infections Recurrent Apht...

ULCERATIVE, VESICULAR, AND BULLOUS LESIONS PRESENTED BY :AMIRA ABDELWHAB LECTURER OF ORAL MEDICINE  ACUTE MULTIPLE ULCERS Herpes Simplex Virus Infections Varicella-Zoster Virus Infections RECURRING ORAL ULCERS Cytomegalovirus Infections Recurrent Aphthous Stomatitis NUG & NUP Behçet Disease Erythema Multiforme (SJS & TEN) Oral Hypersensitivity Reactions CHRONIC MULTIPLE ULCERS SINGLE ULCERS Pemphigus Vulgaris PNPP Pemphigus Traumatic Ulcers Vegetans Traumatic Ulcerative Granuloma Bullous Pemphigoid (Eosinophilic Ulcer of Tongue) Mucous Membrane Pemphigoid LAD amira abdelwhab Infectious Ulcers Chronic Bullous Disease of Childhood EBA  Clinical terms 1. Macules: flush with the adjacent mucosa - noticeable because of their difference in color (red or pigmented ex : melanotic macule). 2. Papules: raised above the mucosal surface - smaller than 1 cm in diameter (may be slightly domed or flat-topped ex lichen planus). amira abdelwhab  Clinical terms 3. Plaques: raised lesions that are greater than 1 cm in diameter; they are essentially large papules. 4. Nodules These lesions are present within the dermis or mucosa & may also protrude above the mucosa forming a characteristic dome-shaped structure (ex: irritation fibroma). amira abdelwhab amira abdelwhab 5. Vesicles. These are small blisters containing clear fluid that are less than 1 cm in diameter. 6. Bullae. These are elevated blisters containing clear fluid that are greater than 1 cm in diameter (some use 0.5 cm for oral lesions). 7. Pustules. These are blisters containing amira abdelwhab purulent material and appear yellow. 8. Erosions. These are red lesions often caused by rupture of vesicles or bullae trauma thinning of the epithelium (e.g. lichen planus) 9. Ulcers. These are well-circumscribed depressed lesions with an epithelial defect that is covered by a fibrin clot, resulting in a yellow-white appearance (e.g. aphthous ulcer. amira abdelwhab  Atrophy, erosion and ulceration amira abdelwhab  HERPES SIMPLEX INFECTION amira abdelwhab  There are two types of herpes simplex infection HSV1 HSV2 1. Oral infection 1. Genital infection ❖PHGS ❖Recurrent intraoral herpes ❖Recurrent herpes labialis 2. Dermatitis above waist 2. Dermatitis below waist amira abdelwhab 3. Pharyngeal infection 3. Infection in newborn amira abdelwhab  PRIMARY HERPETIC GINGIVOSTOMATITIS Clinical manifestations Most of the cases run a subclinical course Clinical features: Age: 2-3 y (uncommon before 6 m) ????? maternal IgG that can cross placental barrier amira abdelwhab  Clinical features amira abdelwhab 1. Prodrome: fever, headache, malaise and palpable submandibular and deep cervical lymph nodes 2. Acute marginal gingivitis: intensely inflamed and edematous gingiva amira abdelwhab 3- Vesiculobullous 4- Oral ulcerations lesions ❖Painful ❖Once fever subsides ❖Superficial & round ❖Small Rupture ❖Surrounded by inflammatory halo ❖Multiple ❖Coalesce large irregular ulcer ❖K and NK mucosa & circumoral area amira abdelwhab amira abdelwhab Excessive salivation: saliva contains large amounts of virus which can infect the skin around the lips Fate: self-limiting and resolves within 10-14 days Severe forms of the disease occur in ???????? amira abdelwhab amira abdelwhab  HISTOPATHOLOGY Virus invade and destroy epithelial cell resulting in INTRAepithelial vesicles: Epithelial lining: multinucleated Nucleous: ✓Nuclear inclusion bodies (lipschutz) can be seen ✓homogenous with margination of the chromatin ✓Ballooning degeneration amira abdelwhab  Diagnosis History Cytological Prodromal Gingivitis smear from features vesicles contact w Ulcers Antibody herpes pt ??????? titre (1ry or 2ry ) -ve history of recurrent amira abdelwhab herpes amira abdelwhab  TREATMENT Mild cases Severe oral involvement ❖ Supportive treatment only (self limiting) Antiviral drugs o Bed rest & soft balanced diet ❖ Acyclovir o Analgesic & antipyretic ex paracetamol o >12 y 200mg 5 times daily for 5 days o Local analgesic eg: benzydamine HCL o