VESICULOBULLOUS DISEASE

Viral Pathogenesis Clinical features Histopathology DD /

Treatment
Herpes simplex Primary herpetic Intraepithelial vesicles Tzanck smear
gingivostomatitis Inflammatory cells Serology
Vesicles on Skin oral Exudate Viral culture
mucosa Virus infected epithelial Immunohistoch
Fever cells have emistry
Malaise Glassy homogeneous PCR
Arthralgia nucleus
Lymphadenopathy
Headache
Heal without scar Acyclovir 400
Secondary herpes mg TDS
infection Rest
Vesicles on Lips hard Fluids
palate gingiva Analgesics
Pain Antipyretics
Burning
Map like ulcers
Heal without scar
Herpes labialis (lips )
Herpetic whitlow (
fingers)

Varicella zoster Varicella (child) Virus infected epithelial DNA

Fever cells have homogenous hybridization
Chills nucleus Immuno
Malaise Multinucleated cells histochemistry
Headache No scaring Virus antigen
Rash ( trunk head neck ) typing
Rash–> vesicles–> ulcers
Self limiting
Healing with scar Acyclovir
Encephalitis Vaccine
Pneumonitis available
Zoster (adult)
Pain
Paresthesia of involved
dermatome
Unilateral Rash ( trunk
head neck )
 Unilateral lesion ( oral
facial ocular )
Ramsay hunt syndrome
( facial paralysis
External ear vesicles
Tinnitus
Deafness
Vertigo )
Rash → vesicle → ulcers
Ocular inflammation
Post herpetic neuralgia

HFM disease Children Intraepithelial vesicles Virus culture

Fever Virus infected epithelial Virus antigen
Malaise cells typing
Sore mouth Inflammatory cells
Lymphadenopathy
Pain
Vesicles → ulcers Analgesics
Ulcers are covered by a
yellow fibrinous membrane
and have surrounded
erythematous area
(palate tongue buccal
mucosa )
(feet toes hands )
Heal without scar

Herpangina Childrens Virus antigen

Fever typing
Malaise Throat culture
Dysphagia PCR
Sore throat
Vesicles Antipyretic
( palate buccal mucosa )
Erythematous pharyngitis
Self limiting

Rubella Childrens Virus infected epithelial Serological test

(german Fever cells become necrotic Viral culture
measles ) Malaise Dilated blood vessels PCR
Conjunctivitis and generalized
Photophobia inflammation
Cough Inflammatory cells Rest
Lymphadenopathy Multinucleated Fluids
Small erythematous macrophages ( warthin Analgesics
macules with white finkeldey giant cells )
necrotic centers on buccal
 mucosa ( koplik's spot )

Maculopapular skin rash

( head and trunk )
Encephalitis
Thrombocytopenic purpura
Otitis media
Pneumonia

Immunolog Clinical features Histopathology Immunopatholog DD /

ic disease y Treatment
Pemphigus Autoimmune disease Intraepithelial vesicles Positive IgG type C3 Topical steroids
vulgaris Fragile vesicle → Acantholysis Antigens ; desmoglein Systemic
ulcers Tzanck cells present 1 and 3 corticosteroids
P vulgaris Painfull (prednisone )
P vegetans Ulcers have ragged Azathioprine
P foliaceus borders Dapsone
igA pemphigus Gentle rubbing on
Paraneoplastic unaffected site produce Rituximab
pemphigus strippling of epithelium
( nikolsky sign ) Physician
Dermatologist

MMP Adults Subepithelial Linear pattern Topical steroids

Bullae → ulcers No acantholysis Positive IgG C3 Systemic
( conjunctiva genitals steroids
oral cavity) Prednisone
Blindness Azathioprine
Hoarseness of voice
Genital itching Chlorhexidine
Pain mouthwash
Desquamative gingivitis
Heal with scar Rituximab

BP Elderly Subepithelial Linear pattern Systemic

Rash → bullae→ ulcers No acantholysis Positive IgG C3 steroids
( trunk limbs ) Antigens ; Prednisone
( buccal mucosa BP 230 and BP 180
palate) Antibiotics
Tetracycline

Rituximab

Dermatitis Adults Papillae of dermis ( Granular pattern Gluten free diet

herpetiformis Vesicles connective tissue involved) Positive IgA C3 on Dapsone
(elbow knees buttocks) Inflammatory cells connective tissue
 ( oral mucosa ) papilla

Linear IgA Bullae Subepithelial Linear pattern Dapsone

bullous disease ( oral mucosa ) No acantholysis Positive IgA antibodies
( trunk limbs ) At basement membrane Antigen BP180
Two types Collection of bulla
1. Children called rosettes
2. Adult

Hereditary Clinical features Histopathology Immunopatholog DD /

disease y Treatment
Epidermolysis Blister formation at site Subepithelial Linear pattern Systemic
bullosa of trauma No acantholysis Positive IgA C3 steroids
Simplex Antigen type 7 collagen
Two types Less severe type Dapsone
Hereditary Bulla on oral mucosa
Simplex Soles of feet Vitamin E
Dystrophic
Junctional Junctional and Avoid trauma
dystrophic
Acquired Lethal type
Epidermolysis Severe blisters on oral
bullosa mucosa
acquisita Blisters → erosions
Scar formation