Vesiculobullous Lesions Research Articles

The trend of cutaneous lesions during COVID-19 pandemic: lessons from a meta-analysis and systematic review.

Besides predominant respiratory and gastrointestinal manifestations, reports on cutaneous manifestations in COVID-19 patients are being noted increasingly. To estimate the prevalence of cutaneous manifestations in COVID-19 patients. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A detailed literature search was done in PubMed and Embase from December 1, 2019, till May 1, 2020. Studies reporting cutaneous manifestations in COVID-19 patients were included. Irrespective of the heterogeneity of data, a random effects model with inverse-variance approach was used for pooling the prevalence using meta package in R version 3.6.2. Out of 15,143 articles, 2086 articles were selected for full-text read. Forty-three articles were selected for qualitative analysis, of which 10 articles (N=1682) were included for meta-analysis. The pooled prevalence of overall cutaneous lesions was 5.69 (95% confidence interval [CI]: 1.87-15.98; I2 88%). The pooled prevalence of other outcome parameters were as follows: viral exanthem-like presentation 4.15 (95% CI: 1.33-12.23; I2 88%), maculopapular rash 3.81 (95% CI: 1.02-13.18; I2 87%), vesiculobullous lesions 1.67 (95% CI: 0.70-3.96; I2 0%). The estimated prevalence of cutaneous manifestations in COVID-19 was 5.69%. Other manifestations were urticaria, chilblain-like lesions, livedo reticularis, and finger/toe gangrene. Although it is premature to conclude the prevalence of the cutaneous manifestations during this ongoing pandemic, our report may be a stimulating factor for the physicians to perform further vigilant streamlined reporting of cutaneous manifestations in COVID-19 patients to estimate the final prevalence.

Association of antinuclear antibodies with toxic epidermal necrolysis – A novel manifestation

Toxic epidermal necrolysis (TEN) is a potentially life-threatening dermatologic disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis of skin and mucous membranes, resulting in exfoliation and possible sepsis and/or morbidity/mortality. Exact diagnosis of lesions is very important in terms of therapeutic intervention as well as outcome. As cutaneous hypersensitivity reactions are known to occur with increased frequency in connective tissue disease, differentiating lesions of systemic lupus erythematosus that simulate drug-induced TEN is a challenge in the practical scenario. In this case series, we discuss about three patients aged between 24 and 67 years, who presented with vesiculobullous lesions all over the body and oral mucosal ulcerations. Each of them was initially admitted in the Critical Care Unit with a provisional diagnosis of TEN. Two of the three patients recovered well and were discharged. However, the third patient, who was the oldest and had multiple comorbidities, could not be saved and succumbed after 75 days of hospital stay.

LYMPHANGIOMA: A CASE REPORT

The lymphangiomas are benign hamartomatous tumors that result from congenital or acquired abnormalities of the lymphatic system. They are rare in adults and frequently localized in the head and neck regions. When they occur in the oral cavity the most common location is dorsum of the tongue. The goal of this case report is to present the diagnostic methods based on clinical and histopathologic criteria as well the surgical treatment of choice. A 56-year-old female patient presented with a white painless vesiculobullous lesion on her lower lip for at least 8 years according to the patient’s report. The excisional biopsy was performed as surgical treatment, and the diagnosis of lymphangioma was confirmed by histopathologic examination. Although it is a rare condition, it is extremely relevant to perform the diagnosis of this condition and the adequate treatment. The lymphangiomas are benign hamartomatous tumors that result from congenital or acquired abnormalities of the lymphatic system. They are rare in adults and frequently localized in the head and neck regions. When they occur in the oral cavity the most common location is dorsum of the tongue. The goal of this case report is to present the diagnostic methods based on clinical and histopathologic criteria as well the surgical treatment of choice. A 56-year-old female patient presented with a white painless vesiculobullous lesion on her lower lip for at least 8 years according to the patient’s report. The excisional biopsy was performed as surgical treatment, and the diagnosis of lymphangioma was confirmed by histopathologic examination. Although it is a rare condition, it is extremely relevant to perform the diagnosis of this condition and the adequate treatment.

Localized morphea profunda: An atypical presentation

Morphea profunda is a variant of localized scleroderma, in which inflammation and sclerosis are found in the deep dermis, panniculus, fascia, or superficial muscle. It generally presents as diffuse, taut, and thickened skin, which is bound to the underlying tissue. Most cases have widespread involvement, but localized lesions have also been reported. We report a case of localized morphea profunda presenting with papular and vesiculobullous lesions on the overlying skin in a 50-year-old female patient who was successfully treated with methotrexate and systemic steroids.

Bullous systemic lupus erythematosus: exceptional and challenging presentation

Vesiculobullous lesions can be developed by less than 5% of patients with systemic lupus erythematosus (SLE). Among these lesions, bullous systemic lupus erythematosus (BSLE) is one of the rarest and most challenging cutaneous presentations of the disease. Its frequency in the largest series of 5149 patients with cutaneous lupus was 0.19%, and the majority of cases are reported as sporadic observation or small series not exceeding ten cases. We report the original observation of BSLE revealing SLE in 32-year-old Tunisian Woman. This atypical presentation of cutaneous lupus deserves to be known by clinicians and discussed in front of any bullous dermatosis, particularly in young woman.

Study of Various Vesiculobullous Lesions Using Tzanck Smear

Background: The vesiculobullous reaction pattern is characterized by the presence of vesicles or bullae within the epidermis or at the dermoepidermal junction. Despite some having characteristic presentations, it’s difficult to make a definite diagnosis clinically. Hence, cytological evaluation is required for reliable and early diagnosis. Objectives of the study are to determine the incidence of various vesiculobullous lesions and evaluate cytology as a tool for early diagnosis of vesiculobullous lesions.
 Methods: For Tzanck smears fresh vesicle or bulla was selected and incised with scalpel, reflecting the roof of bulla. Base of the blister scraped gently and material spread on a glass slide. These smears were stained with MGG (air dried), Pap and H&E stains (fixed).Skin punch biopsies from the bullae were subjected to routine fixation, processing, sectioning and staining.
 Results: A total of 62 Tzanck smears were done for vesiculobullous lesions of skin of which 29 had histopathological correlation. Herpes constituted the most common vesiculobullous disorder (42%) followed by bullous pemphigoid (27.4%) and pemphigus vulgaris (19.3%). Most patients were in the age group 61- 70 years. The M:F ratio of 1:1.38 showing female preponderance. Tzanck smears showed acantholytic cells in pemphigus group, eosinophils in bullous pemphigoid and multinucleate giant cells in viral blisters. Histopathology showed intraepidermal acantholysis in pemphigus vulgaris, subcorneal blister in pemphigus foliaceus and subepidermal in bullous pemphigoid.
 Conclusion: Cytohistopathological correlation showed an overall sensitivity of 79%. Tzanck smear showed 96% sensitivity for viral infections. Tzanck smear is a quick, non-invasive method for the early diagnosis of vesiculobullous disorders.

Non neoplastic skin lesions: A histopathological study based on punch biopsy

Introduction: Skin diseases can be diagnosed by clinical examination but diagnostic procedures are required for valuable information to reach towards final diagnosis. A few such procedures are skin biopsy. It can be obtained by various ways, amongst them punch biopsy is the standard procedure. Aims and Objectives: The present study is carried out to analyze the incidence, age and sex wise distribution of various dermatological lesions presenting to tertiary care hospital and to study their histopathological findings. Materials and Methods: This study was carried out at Department of Pathology, Tertiary Care Hospital, Ahmedabad for a period of 6 months (June 2019 to December 2019). With necessary clinical details in a performa, punch biopsy section was sent to Histopathology section for confirmation of clinical diagnosis. Formalin fixed, paraffin embedded sections were prepared and slides were routinely stained with H & E and special stains were applied wherever necessary. Data obtained was analysed and tabulated. Results: Total 220 cases were analysed. Male: Female ratio is 1.3:1. The most common clinical lesion was Hypopigmented patch. Leprosy was the most common Histopathological diagnosis reported (18.1 %) followed by Vesiculobullous lesions (11.8%). Conclusion: Punch biopsy is a very simple outpatient procedure and very useful for skin lesions. Leprosy is still the most common skin disease for which biopsies are done followed by Vesiculobullous lesions.

Incontinentia Pigmenti with Extensive Brain Infarction in a Newborn

Incontinentia pigmenti (IP) is a rare X-linked dominant neuroectodermal multisystemic disorder with characteristic skin lesions. In addition to skin lesions, the teeth, nails, hair, eyes, and central nervous system are involved. Central nervous system involvement in the neonatal period may cause intellectual disabilities, severe neurologic impairment, or death. IP is associated with mutations in the NF-kappa B essential modulator gene located on chromosome Xq28 and is most commonly seen in female patients. We experienced one case of a newborn with multiple vesiculobullous skin lesions over the entire body after birth and partial seizures with secondary generalization. The brain magnetic resonance imaging showed extensive cerebral infarction, and retinal hemorrhage was observed in the fundus examination. The patient was clinically diagnosed with incontinentia pigmenti. Key words: Incontinentia pigmenti; Cerebral infarction; Retinal hemorrhage; NEMO gene

Oral vesiculobullous lesions associated with SARS-CoV-2 infection.

Oral vesiculobullous lesions associated with SARS-CoV-2 infection.

Benign Mucous Membrane Pemphigoid: A Case Report

Benign Mucous Membrane Pemphigoid (MMP) is a vesiculobullous (VB) lesion that affects oral and nasal mucosa, oropharynx, conjunctiva, and genital mucosa. It is considered an autoimmune disease. Autoantibodies are produced due to several external factors or genetic factors. It creates many complications, such as defects in vision, voice alteration (hoarseness), airway obstruction, and dyspareunia. The subepithelial blisters form due to these antibodies. Treatment modalities differ from topical steroids to systemic steroid therapy based on the nature and severity of clinical symptoms.

Toe Gangrene Revealing Septicaemical Rat-bite Fever: About a 41 Day Old Infant

Rat-bite fever (RBF) is a systemic infectious disease. It is due to Streptobacillus moniliformis, a commensal bacterium of the nasopharyngeal mucosa of small rodents, in particular rats. This anthropozoonosis is rare in urban areas. The first clinical sign of infection is a fever, followed by polyarthritis and a rash. It can only start with skin signs, as in our observation. We report the case of a 41-day-old female infant who was the victim of a rat bite at one month of life in the upper nasal and labial areas. A rabies vaccine with local care has been made. The clinical course at 3 days after the bite was marked by a non-pruritic papulopustular rash, the vesiculo-bullous lesions in the bilateral and symmetrical legs evolved into inflammatory ulcerative necrotizing lesions in a geographic map of the lower 1/3 of the lower limbs with gangrenous lesions in the toes, an erythematous base on the face, hands and feet and discreet oral erosions, associated with generalized purpuric spots and fevers at 40°C. The biological assessment was carried out objectifying an inflammatory syndrome made of a leukocytosis at 26770/mm3, with neutrophils at 10842/mm3, CRP = 215 mg/L. The diagnosis of RBF was made by the isolation of a Gram-negative bacillus in a blood culture. The final identification of the germ was carried out by molecular biology (PCR of 16S rRNA). The lumbar puncture was negative and the cardiac ultrasound was without abnormality. Arterial and venous Doppler ultrasound of the lower limbs was normal. The diagnosis of rat bite fever having been retained. The infant was put on cefpodoxime IV for 3 weeks and metronidazole IV for 10 days. The clinical course at 3 months later, spontaneous amputation of gangrenous toes with residual skin scars was noted.

Where in the World Did You Get That Rash?

1. Panteha Eshtiaghi, HBSc* 2. Miriam Weinstein, MD, FRCPC† 1. *Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 2. †Hospital for Sick Children, Toronto, Ontario, Canada * Abbreviations: ACD: : allergic contact dermatitis CD: : cercarial dermatitis CL: : cutaneous leishmaniasis CLM: : cutaneous larva migrans DF: : dengue fever HFMD: : hand, foot, and mouth disease HSV: : herpes simplex virus KD: : Kawasaki disease PCR: : polymerase chain reaction PR: : pityriasis rosea RT-PCR: : reverse transcriptase polymerase chain reaction The challenge to diagnose cutaneous eruptions and lesions in patients who have spent time in foreign countries is increasingly common. With the advent of increased global travel, foreign adoptions, immigration, and refugee seekers, rashes that were once relegated to the realm of the exotic and likely to show up in a tropical diseases clinic may now present to a general pediatrician. Furthermore, the pediatric traveler is at increased risk for dermatoses. (1) It behooves the practitioner to be aware of these skin findings, to be able to recognize them and distinguish them from other skin conditions. After completing this article, readers should be able to: 1. Identify and classify rashes by main morphologic patterns. 2. Develop a broad differential diagnosis and diagnostic approach for a rash in a returned pediatric traveler based on initial morphology, history, epidemiology, and other clinical features. 3. Consider both infectious and noninfectious causes of skin disorders presenting in a patient with a travel history. 4. Outline the basic investigations and principles of management for travel-acquired and non–travel-acquired dermatologic illnesses. 5. Discuss …

Clinico-histopathological Study of Vesiculobullous Lesions of the Skin at Tertiary Care Centre

Clinico-histopathological Study of Vesiculobullous Lesions of the Skin at Tertiary Care Centre

Oral Pemphigus Vulgaris: A case report

Pemphigus vulgaris is an autoimmune blistering disease clinically presenting as vesicles, bullae and erosion on the skin and mucous membrane. Histopathologically, it is characterized by acantholy­sis and supra basilar split. The underlying mechanism causing intra epithelial split in pemphigus vulgaris is binding of IgG autoantibodies to desmoglin 3 which belongs to a transmembrane gly­coprotein adhesion molecule. Here we present a case of 27 years old male patient suffering from pemphigus vulgaris. This Case report highlights the importance of detailed case history, thorough clinical examination and appropriate investigation to reach a diagnosis of vesiculobullous lesion.

ORAL PEMPHIGUS VULGARIS: A CASE REPORT

Pemphigus vulgaris is an autoimmune blistering disease clinically presenting as vesicles, bullae and erosion on the skin and mucous membrane. Histopathologically, it is characterized by acantholy­sis and supra basilar split. The underlying mechanism causing intra epithelial split in pemphigus vulgaris is binding of IgG autoantibodies to desmoglin 3 which belongs to a transmembrane gly­coprotein adhesion molecule. Here we present a case of 27 years old male patient suffering from pemphigus vulgaris. This Case report highlights the importance of detailed case history, thorough clinical examination and appropriate investigation to reach a diagnosis of vesiculobullous lesion.

Bullous Cutaneous Larva Migrans And Generalized Cutaneous Larva Migrans: A Rare Clinical Manifestation

Background: The skin lesions of Cutaneous Larva Migrans (CLM) commonly manifests as single, linear, irregular, serpiginous raised erythematous track, but the other clinical variants exist. This case series aimed to report one case of a vesiculobullous lesion in CLM and one case of CLM with generalized distribution serpiginous erythematous skin lesion. Objectives: We report one case of a vesiculobullous lesion in CLM and one case of CLM with generalized distribution serpiginous erythematous skin lesion. Conclusion: There were CLM with vesiculobullous lesions and also with generalized distribution of skin lesion. The pathogenesis of this condition is still unknown. In both cases, albendazole 400 mg per day for 3 and 5 days gave an effective result.

Acetaminophen‐induced atypical Stevens‐Johnson syndrome in a patient with acute oral bacterial infection: A case report and literature review

AbstractStevens‐Johnson syndrome (SJS) is a rare but fatal disease and is characterized by various clinical symptoms, including acute inflammatory vesiculobullous lesion of skin, oral cavity, ocular surface, genitals, etc Drugs, such as anti‐epileptic drugs, antibiotics, pain killers/antipyretics, and/or bacterial infections have been widely known to cause SJS. Herein, we report a 40‐year‐old man with atypical SJS caused by acetaminophen, which was used for treating an acute odontogenic infection. The patient presented with several risk factors associated with SJS; thus, careful monitoring of the patient's drug history is mandatory to treat acute inflammation in the oral cavity.

Cardiac function in pemphigus vulgaris patients before and after steroid pulse therapy

Background Pemphigus vulgaris which is an autoimmune dermatological disorder characterized by vesiculobullous lesions over the skin and mucosae may also give rise to cardiac disease. Global Longitudinal Strain (GLS) measurement may help to predict cardiac dysfunction in these patients. Method In this prospective study, the GLS was measured before and after steroid pulse therapy in pemphigus vulgaris patients using 2 D speckle-tracking echocardiography. Moreover, blood pressure, pulse rate, and corrected QT (cQT) interval were recorded before and after steroid pulse therapy. Results We included 23 pemphigus patients. The mean age of patients was 34.5(±6.4). Mean GLS decreased significantly after the administration of steroid pulse therapy. The mean GLS decreased regardless of age, however, the patients with the age range of 40–50 years showed the highest change in GLS. There was no interaction between gender and GLS change. Mean cQT increased significantly after pulse therapy (p=.007). Heart rate increased significantly from 88.5 ± 10.8 to 97.0 ± 13.4 (p<.001). Mean systolic and diastolic blood pressure did not show any significant change. Conclusions The steroid pulse therapy may associate with the progression of cardiac dysfunction in pemphigus patients. GLS, as a predictor, may be a valuable marker of cardiac subclinical dysfunction in this condition.

Clinicopathological study of vesiculobullous lesions of the skin and the diagnostic utility of immunofluorescence

Introduction: Vesicobullous disorders represent a heterogenous group of dermatoses with protean manifestations in which the primary lesion is a vesicle or a bulla on the skin or mucous membrane or both. These lesions can be extremely debilitating, may have serious sequelae, and even fatal, necessating early treatment and intervention to prevent further morbidity and mortality. Many of these blistering diseases mimic each other clinically, Histopathology together with immunofluorescence are used for diagnosing vesiculobullous lesions of skin. Materials and Methods: The present study is done at out institute for a period of 3 years from 2016 to 2019 All the vesiculo bullous lesions which we received during this period have been included in our study. We received a total of 42 cases during our study period. Light microscopic examination followed by DIF was done for definitive diagnosis. The pattern and distribution of immune complex deposits was analysed under fluorescence microscope and correlated with histological findingsResults: Bullous pemphigoid was the common vesiculobullous disease (38.09%) followed by pemphigus vulgaris. dif showed linear type of immune deposits in epidermal basement membrane zone in bullous pemphigoid and in pemphigus vulgaris intercellular lace like deposition of immune complexes was seen.Conclusion: Vesiculobullous disorders represent a heterogeneous group of dermatosesPunch biopsy of the skin is a simple, inexpensive, safe OPD procedure, causing minimal discomfort lesions and DIF studies are an adjunct to the histomorphology.DIF which is the gold standard and sensitive test in making a definitive diagnosis aids in distinguishing non immune lesions from immune mediated lesions which pose a diagnostic dilemma both clinically and histologically An integrated approach of clinical findings in conjunct with histomorphology and DIF assist in accurate diagnosis and proper patient management.

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.