Vesiculobullous Lesions Of The Oral Cavity

Vesiculobullous Lesions Of The Oral Cavity

Question. Enumerate vesiculobullous lesions and describe pemphigus.

Answer.

Pemphigus

Pemphigus is a group of vesiculobullous lesions of the skin and mucous membrane, which is characterized by the formation of intraepithelial vesicles or bulla, causing separation ofthe epithelium.

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Clinical Features Of Pemphigus

• It occurs during the 4th, 5th, and 6th decades of life and is more prevalent among females.
• Rapidly developing vesicle or bulla on several areas of skin and mucous membrane, which initially contain clear fluid, but later on, there is formation of pus.
• Vesicle ruptures very soon and leaves painful, erythematous ulcers that bleed profusely.
• Gentle traction or oblique pressure on and affected area around the lesion causes stripping of the normal skin or mucous membrane which is known as “Nikolsky’s Sign”.
• The patient may die due to dehydration and septicemia.

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Histopathology Of Pemphigus

• Formation of a vesicle or bulla within the epithelium that results in the supra-basilar split.
• Following the suprabasal split the basal cell layer remains attached to lamina propria and appears as row of “Tomb Stone”.
• Loss of intracellular bridges and collection of edema flid results in acantholysis within spinous cell layer which causes disruption of prickle cell layer.
• As a result of acantholysis, clumps of large hyperchromatic epithelial cells lie free within the vesicular fluid; these desquamated cells are round and smooth in appearance and are known as Tzanck cells.
• A small number of PMNs and lymphocytes may be found.

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Treatment Of Pemphigus

• High dose of steroids
• Immunosuppressive agents
• Antibiotics to prevent secondary infection.
• Fluid and electrolyte balance must be strictly maintained.