Vesiculobullous Lesions Research Articles

A Profile of 23 Indian Patients with Purpura Fulminans: A Retrospective, Descriptive Study.

Background:Purpura fulminans (PF) is a potentially fatal uncommon disorder of intravascular thrombosis and is clinically characterized by rapidly progressive hemorrhagic infarction of the skin.Objective:To describe the clinical feature and outcome of a series of patients with PF.Materials and Methods:A descriptive study based on review of case records was carried out at a tertiary care hospital in Kolkata.Results:Twenty three consecutive cases seen over a period of 8 years were studied. The age range was 4 days to 78 years (mean 35.6 years) with a male to female ratio of 1:2.8. Hemorrhagic rash was the universal presenting symptom. Other major presenting features included pneumonia (26.1%), sudden-onset shock syndrome (21.7%), and urinary tract infection (17.4%). All patients presented with retiform purpura and lesional necrosis and 8 (34.8%) patients had associated peripheral gangrene. Nineteen (82.6%) patients had sepsis and 60.9% patients had vesiculo-bullous lesion. Pneumococcus was the most common (26.1%) pathogenic organism detected. The precise cause of PF could not be detected in two (8.7%) patients. One patient (4.3%) with neonatal PF had protein C deficiency. All patients had evidence of disseminated intravascular coagulation (DIC). One patient had to undergo a below knee surgical amputation and one patient had autoamputation of the digits. Ten (43.5%) patients succumbed to their illness. Seven of the 8 patients who had peripheral gangrene had a fatal outcome.Limitations:Relatively small sample size and a referral bias were a few limitations of the present study.Conclusion:The present study emphasizes that PF is a cutaneous marker of DIC. Association of peripheral gangrene, leukopenia and neutropenia may be the reason for the high mortality rate.

TEN in a Case of SLE - A case based review

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder of unknown etiology. Cutaneous manifestations in SLE are common, results in significant morbidity and helpful in diagnosis of underlying systemic disease. Vesiculobullous lesions in SLE are uncommon but present a diagnostic challenge. It can be a manifestation of SLE-specific or nonspecific pathology. It can also result from unrelated etiology such as drug-induced toxic epidermal necrolysis (TEN). Clinically, it is challenging to differentiate TEN-like acute cutaneous lupus erythematosus from classical TEN. We hereby present a case of TEN in SLE and discuss approach to vesiculobullous lesions in SLE.

From the Case Records of Kanchi Kamakoti CHILDS Trust Hospital: Fever with Vesiculobullous Lesions

From the Case Records of Kanchi Kamakoti CHILDS Trust Hospital: Fever with Vesiculobullous Lesions

Vaccine–induced childhood pemphigus vulgaris: A case report in a 5-year-old female child

Pemphigus vulgaris (PV) is an immunobullous disease affecting the skin and mucosa. It is a disease most commonly manifesting in the third–fifth decades of life. Pediatric PV is rare and usually seen at a mean age of 12 years. Early childhood PV is extremely rare with only few cases reported. There are various inducers of PV in children. Diphtheria toxoid (DT) has rarely been reported as an inducer of PV. We report a 5-year-old female child who developed vesiculobullous mucocutaneous lesions after DT vaccination. The diagnosis was confirmed by histopathology and immunofluorescence. She was treated with pulse methylprednisolone therapy and daily dose azathioprine.

Prevalence of ulcerative stomatitis in arbovirus infections in a Brazilian Northeast population.

Background Although there are no population-based studies that support an association, there are reports in the literature of mucocutaneous, vesiculobullous and ulcerated lesions in the oral mucosa in cases of arbovirus infection. The aim of this study is to analyze the prevalence of ulcerative stomatitis in individuals affected by arboviruses in a population of the municipality of Arcoverde, Pernambuco, Brazil. Material and Methods 1,003 people living in an area assigned to a Primary Health Care Unit were interviewed. A structured questionnaire was used for data collection, with questions about sociodemographic variables, residence conditions, general health information, as well as information about the general signs and symptoms of arboviruses and specifically about oral lesions. Results Of the 1,003 individuals interviewed, 815 (81.25%) were infected by one or more arboviruses. Of these, 147 (18%) reported ulcerated oral lesions during arbovirus infections. The association between arbovirus infections and the presence of ulcerated oral lesions was statistically significant (p = 0.000). Conclusions In these cases, the ulcerated lesions on the oral mucosa appear to be associated with arbovirus infection, especially Chikungunya, although the pathophysiological mechanisms are not defined, and the studies are not sufficient to confirm this association. Key words:Arbovirus infections, Dengue, Chikungunya fever, Zika virus.

Teledentistry support in COVID-19 oral care

Given the latest updates in scientific publications about the impact of COVID-19 on oral health, such as the role of salivary glands as potential reservoirs for SARS-CoV-2 (), the appearance of possible oral vesiculobullous lesions (), and the presence maculopapular manifestations in suspected and confirmed cases (), we aimed to emphasize the inexorable need for close monitoring by a dentist specialized in oral medicine in such COVID-19 patients. Their skill and accuracy in diagnosing mouth diseases could contribute to a [...]

Frequency of Type 8 Human Herpes Virus in Patients with Pemphigus Vulgaris in Tabriz Sina Hospital since 2016-2017

Background: Pemphigus vulgaris is the most common form of autoimmune vesiculobullous skin disease. Human herpesvirus-8 (HHV-8) has a well-known association with Kaposi's sarcoma. Considering the reports about the incidence of Kaposi's sarcoma in patients with pemphigus and bolus pemphigoid without evidence of HIV infection, this study was designed to investigate the presence of HHV-8 in patients with pemphigus. Methods: In this cross-sectional and descriptive-analytic study, 27 patients with newly diagnosed pemphigus vulgaris were selected. The control group included 27 patients with benign non- vesiculobullous skin lesions. IHC (Immunohistochemistry) staining was performed to detect HHV-8 in tissue samples taken from skin lesions or mucosal lesions in both groups. Results: IHC showed HHV-8 in 12 patients in case group with pemphigus vulgaris (44.4%) and 9 patients in control group (33.3%) (P=0.402). Conclusion: Although HHV-8 prevalence was higher in Pemphigus vulgaris patients, this difference was not statistically significant, and there is unlikely to be a causal relationship between HHV-8 and Pemphigus.

An Unusual Case of Orf with Erythema Multiforme and Vesiculo-bullous Lesions after Eid al-Adha

An Unusual Case of Orf with Erythema Multiforme and Vesiculo-bullous Lesions after Eid al-Adha

Oral Ulcers Presentation in Systemic Diseases: An Update.

BACKGROUND:Diagnosis of oral ulceration is always challenging and has been the source of difficulty because of the remarkable overlap in their clinical presentations.AIM:The objective of this review article is to provide updated knowledge and systemic approach regarding oral ulcers diagnosis depending upon clinical picture while excluding the other causative causes.METHODS:For this, specialised databases and search engines involving Science Direct, Medline Plus, Scopus, PubMed and authentic textbooks were used to search topics related to the keywords such as oral ulcer, oral infections, vesiculobullous lesion, traumatic ulcer, systematic disease and stomatitis. Associated articles published from 1995 to 2019 in both dental and medical journals including the case reports, case series, original articles and reviews were considered.RESULTS:The compilation of the significant data reveals that ulcers can be classified according to (i) duration of onset, (ii) number of ulcers and (iii) etiological factors. Causation of oral ulcers varies from slight trauma to underlying systemic diseases and malignancies.CONCLUSION:Oral manifestations must be acknowledged for precise diagnosis and appropriate treatment.

<p>Vesiculobullous diseases in relation to lupus erythematosus</p>

Vesiculobullous lesions in lupus erythematosus (LE) are a rare cutaneous manifestation of cutaneous and/or systemic LE with variable presentation. While the minor forms of LE-associated vesiculobullous disease may cause disfigurement and discomfort, the severe forms can present with hyperacute reaction and life-threatening consequences. Specific LE and aspecific cutaneous LE are defined by the presence or absence of interface change on histopathology that can be applied to vesiculobullous diseases in relation to LE. However, the diagnosis of LE-associated vesiculobullous diseases remains difficult, due to the poorly defined nosology and the similarities in clinical and immunohistopathological features among them. Herein, we thoroughly review the topic of vesiculobullous skin disorders that can be encountered in LE patients and organize them into four groups: LE-specific and aspecific vesiculobullous diseases, LE-related autoimmune bullous diseases, and LE in association to non-autoimmune conditions. We sought to provide an updated overview highlighting the pathogenesis, clinical, histological, and immunopathological features, laboratory findings, and treatments and prognosis among vesiculobullous conditions in LE.

Histopathological spectrum of Nonneoplastic, nonpigmented skin lesions in a tertiary care centre: A prospective study with clinical perspective

Context: Nonneoplastic, nonpigmented skin lesions offer a vast variety of interesting array of histopathological diagnosis. Punch biopsy is a very rapid, effective and noninvasive method towards histopathological diagnosis of such skin lesions. Proper institution of therapy is possible with minimal discomfort. Aim: Aim was to study the histopathology of punch biopsies in a variety of skin in patients attending the dermatology OPD. Also an attempt was made to calculate percentage of different nonneoplastic, nonpigmented skin lesions and compare it with the prevalence. Materials and Methods: Punch biopsies from 103 skin lesions were processed and histopathological examination of the H&E stained sections was done. The patients were followed through the wards after the institution of therapy. Results: Out of 103 punch biopsies, 48 cases were offered a diagnosis of dermatitis, 36 were Vesiculobullous lesions, of which 27 were Pemphigus vulgaris, 6 were bullous pemphigoid, 2 Dariers disease, 2 Pemphigus foliacious, 1 IgA Pemphigus, 9 cases of leprosy, 2 each of psoriasis and Discoid Lupus Erythematosus, 1 case each of scleroderma, Steven Jhonsons disease, lichenoid eruption and focal cutaneous mucinosis. Clinical findings and clinical diagnosis were a great help in arriving at a definitive diagnosis. Conclusion: Nonneoplastic and nonpigmented lesions form a very small portion of surgical pathology specimens. Clinical examination along with histopathological examination of skin together help to arrive at correct diagnosis of diseases. Punch biopsy is a simple, inexpensive, safe OPD procedure, causing minimal discomfort to the patient and no scarring. More skin lesions should be subjected to punch biopsy to know the exact diagnosis and progress of the disease and thus help in better therapeutic intervention.

A rare presentation of chikungunya in an infant

Chikungunya is an arboviral disease caused by chikungunya virus which belongs to the genus Alpha virus and Togaviridae. It is transmitted by Aedes aegypti and Aedes albopictus mosquitoes. The important reasons for the outbreaks are genetic adaptation of the virus and adaptation of the mosquitoes to the cold climate which lead to increased infectivity and dissemination. The clinical manifestations of disease in infants are different from that of older children and adults. Various dermatological manifestations of chikungunya include generalized erythema, maculopapular rash, vesicular lesions, hyper pigmentation and peeling of skin. Authors hereby report a case of 10 month old infant with fever and vesiculobullous lesion which was diagnosed as chikungunya infection.

Mucous membrane pemphigoid and oral blistering diseases.

The autoimmune blistering disorders present with variable frequency in the oral cavity. Recognition of their key clinical features at presentation is important, as there are many causes of oral ulceration. Careful history-taking, clinical examination, an understanding of pathogenesis and appropriate investigations are essential. With the exception of the rare genodermatoses that may lead to blistering and oral ulceration, the majority of patients have an acquired disorder. These include the rare autoimmune blistering diseases mucous membrane pemphigoid (MMP), pemphigus vulgaris (PV), linear IgA disease, epidermolysis bullosa acquisita and paraneoplastic pemphigus. Important clinical differential diagnoses include erythema multiforme, which may be mistaken for PV in appearance, while oral lichen planus may be indistinguishable from MMP. Angina bullosa haemorrhagica may also present with tense haemorrhagic bullae, and in the absence of diagnostic tests, requires an astute clinical diagnosis based upon the history. Newer laboratory techniques have facilitated identification of target antigens and epitopes in the autoimmune blistering diseases, particularly in MMP. Current interest is in whether these relate to clinical presentation and outcomes. There have also been recent investigations into the use of saliva as an alternative medium to serum for the diagnosis of oral vesiculobullous lesions. Assessment of disease severity and measurement of quality of life at presentation and subsequent follow-up is paramount to interpreting therapeutic response. Furthermore, combining these scores with serological and/or salivary biomarkers is valuable in the assessment of clinical response. In this paper, we discuss MMP and its important differential diagnoses.

The Diagnostic Value of Tzanck Test in Vesiculobullous, Pustular, and Oral Lesions in The Dermatology Clinic

Background: Vesiculobullous disorders represent a heterogeneous group of dermatoses with protean manifestations. The accurate diagnosis of bullous disorders of the skin and mucous membrane requires evaluation of clinical, histological, and immunofluorescence findings. Objective: The aim of this study was to investigate Tzanck smear findings and to determine the diagnostic value of this test in moist (erosive, vesicular, bullous, and pustular) skin and oral lesions. Patients and Methods: This cross sectional study was conducted on one hundred patients presented with vesicular, bullous, and pustular skin lesions and/or oral lesions. All patients were included from Dermatology Outpatient Clinic at Al-Zahraa University Hospital over the period from March 2018 to March 2019. Results: Positivity of multinucleated giant cells in herpetic infection, acantholytic cells in pemphigus, dyskeratotic acantholytic cells and cocci in bullous impetigo were useful landmarks in Tzanck smear. A decrease in viral shedding from herpetic lesions of longer duration may correlate with the lower sensitivity of the Tzanck smear. Therefore, in this study we excluded the lesions older than 3 days. The percentage of positivity in vesicles was much higher than that of pustules. Conclusion: According to this study, Tzanck smear was an inexpensive, simple, and rapid test and did not require any specialized laboratory equipment for evaluation of various vesiculobullous and pustular lesions either skin or mucosal one.

Clinico-pathological evaluation of non-neoplastic and neoplastic skin lesions: A study of 100 cases

Clinico-pathological evaluation of non-neoplastic and neoplastic skin lesions: A study of 100 cases - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/2394-6792.2019.0021, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Study of varied cutaneous manifestations of chikungunya fever

Introduction: Chikungunya fever is an arboviral disease transmitted by infected Aedes mosquitoes. It is characterized by acute onset of fever, associated with severe disabling arthralgia. Mucocutaneous manifestations occur in about half of these patients. Aim: To study the mucocutaneous manifestations in suspected cases of chikungunya. Materials and Methods: Patients attending dermatology outpatient department with fever and rash were screened for chikungunya. Clinical examination was done and mucocutaneous manifestations recorded. Diagnosis was confirmed by serological testing. A total of 50 patients were enrolled in the study. Results: Generalized erythematous maculopapular rash was the most common cutaneous manifestation. Multiple ulcers with erythema over genital region in males was the second most common presentation. Centro facial pigmentation and discrete hyperpigmented macules on trunk and face, urticarial rash, crusted lesions near angle of mouth, erythema/edema over hands and feet were other findings. Generalized erythema multiforme like lesions were also observed in two patients. Vesiculobullous eruptions, which have been reported commonly only in infants, were found in one adult patient in our study. Exacerbation of pre-existing skin lesions and Erythema nodosum like lesions reported in literature were not seen in our study. Conclusion: Vesiculobullous lesions have been reported as a common cutaneous manifestation of chikungunya fever in infants. Vesiculobullous lesions occurring in an adult, however, have not been reported previously, to the best of our knowledge. Keywords: Chikungunya, Cutaneous manifestations, Vesiculobullous lesions.

Clinical photography: Attitudes among dental students in two dental institutions.

Clinical photography is an important tool in teaching, clinical practice and academia especially for mucosal pathologies. Our aim was to examine differences in attitude towards clinical photography for mucosal pathologies among students. Questionnaires about clinical photography were completed by students in dental teaching hospitals in Birmingham (UK) and in Israel (ISR). The questionnaires focussed on the perceived value of clinical photography for a number of purposes and also explored perceived barriers to clinical photography and technology in general. The two departments have different access to clinical photography; in the United Kingdom a separate dedicated photography unit takes all the photographs, whereas in ISR the clinicians take their own photographs. Pearson Chi-squared tests determined statistical significance between categorical variables (P<0.05). Among the 163 respondents, there were no significant differences in the value of photography between countries or genders. The participants felt that the aims of photography included: teaching (99.4%), monitoring premalignancy (97.6%) and clinician communication (95.8%). More than 90% thought photography should be used for dysplasia and erosive lichen planus cases. Respondents from ISR were more in favour of photographing pathologies including simple leukoplakia, reticular lichen planus, vesiculobullous or pigmented lesions (P<0.001 compared to the UK). Overall, the main reasons for not using photography were time constraints (25.5%) and access (21.8%). This study highlights a favourable attitude towards clinical photography for various teaching and clinical indications thereby demonstrating its importance. In order to maximise the benefits of clinical photography, access should be simplified.

A Histomorphological Study of Vesiculobullous Lesions of Skin

Histopathology of skin biopsies is a useful technique in the investigation of various skin diseases, out of which vesiculobullous lesions from one of the predominant groups. Vesicles [blisters less than 0.5 cm in diameter] and bullae [blisters greater than 0.5 cm in diameter] occur in a number of skin conditions1 These blistering disorders are the most visually dramatic of skin disease. Each entity in this group has distinct clinical features and these lesions share a number of histologic features, but only to some extent have common pathogenic mechanisms.The present study showed a prevalence of 74 cases [21% of the total skin biopsies] of Vesiculobullous lesions among the 354 skin biopsies received in the department of pathology over a period of 1 year The age of onset varied from 3 years to 65 years. But the types of lesions varied between the various age groups. The commonest lesion overall was bullous pemphigoid followed by Pemphigus vulgaris.In the present study of 74 cases clinical diagnosis correlated with the histological diagnosis in 64.2% of the cases and in 25.6% of the cases, the diagnosis was done only on histology, where as in 9.4% of the cases it was difficult to offer a conclusive histological diagnosis. This establishes that along with clinical correlation, histo-morphological study forms one of the most useful tool in the diagnosis of Vesiculobullous skin disorders.

Vesiculobullous Lesions: A Comprehensive Overview

Vesiculobullous lesions are defined as a form of muco-cutaneous diseases in which both vescicles and bullae are evident. ‘Vesiculobullous’ sometimes termed as ‘Immunobullous’as decreased immune system of the body causes these diseases. These are either result of range of infections, decreased immunity, drug induced, hereditary or caused by mechanical injury. In all cases ulcerations occur due to rupture of lesions which will further make the diagnosis of lesions difficult to make. This overview will provide a knowledge about the vesiculobullous lesions along with the characteristic’s features affecting the mouth, complete etiopathogenesis, site of occurrence of lesions along with their recent advances in the identification of these lesions. This will also aid in differentially diagnosing the lesions which exhibit similar sign asvesiculobullous lesions but the histopathological examination and immunofluorescence lead to the definitive diagnosis of the lesions.

Herpes simplex virus: A seed or sequelae to pemphigus?

Pemphigus vulgaris is a vesiculobullous lesion in which autoantibodies are produced against desmoglein-3 antigens. Despite having an autoimmune etiology, herpes simplex virus (HSV) is found to be an additional aggravating factor for this disease. Sometimes, there can be a coexistence between the two entities. Here, a unique case of a 65-year-old female patient who presented with the chief complaint of ulcers in the oral cavity for the past 2–3 months is discussed. Histopathologic and immunofluorescence investigations were suggestive of pemphigus, but the cytopathologic smears manifested characteristics indicative of HSV infection. The existence of a viral infection with the known case of pemphigus poses a potential difficulty in the classical treatment of the latter. This case report throws light on the interesting coexistence of these two disease processes, thus highlighting the pathogenesis and treatment plan which may have to be considered in such controversial cases.