Dermatological Diseases Question and Answers

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Oral Medicine Dermatological Diseases Long Essays

Question 1. Enumerate vesiculobullous lesion. Describe in detail the erythema multiform.
(or)
Question 1. Classify vesiculobullous lesions of the oral cavity and Describe in detail erythema multiforme.

Answer:

Vesiculobullous Lesions Classification:

1. Hereditary:

  • Epidermolysis bullosa
  • Familial benign chronic pemphigus
  • Dyskeratosis cangenita

2. Viral:

  • Primary herpetic gingivastomatitis
  • Secondary herpetic gingivostomatitis
  • Chickenpox
  • Herpes zoster virus
  • Measles
  • Infectious mononucleosis
  • AIDS
  • Herpangina

3. Mucocutaneous:

  • Pemphigus Vulgaris
  • Pemphigus vegetans
  • Bullous mucous membrane pemphigoid
  • Lichen planus

4. Miscellaneous:

  • OSMF
  • Hyperacidity
  • Constipation
  • Impetigo
  • Erythema multiforme

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Erythema Multiforme:

  • It is an acute inflammatory disease of the skin and mucous membrane that causes a variety of skin lesions

Erythema Multiforme Etiology:

  • Immune-mediated disease
  • Infections
    • Tuberculosis
    • Herpes simplex
    • Infectious mononucleosis
    • Histoplasmosis
  • Drug Hypersensitivity
    • Barbiturates
    • Sulfonamides
    • Phenylbutazone
    • Salicylates
    • Oral pills
  • Miscellaneous
    • Radiation therapy
    • Crohn’s disease
    • Vaccination

Erythema Multiforme Types:

  • Erythema multiform minor
  • Erythema multi forme major
  • Toxic epidermal necrolysis

Erythema Multiforme Clinical Features:

  • Age and sex: seen in children
  • Site: hands, feet, extensor surfaces of elbow and knees
  • Presentation
    • Rapidly developing erythematous macules, papules, vesicles, or bullae, often appear symmetrically over the hands and arms, legs and feet, and face and neck
    • The classic dermal lesions of it which often appear on the extremities are called “ target, iris, or bull’s eye”
    • These lesions consist of concentric rings separated by near near-normal color of the skin
    • Patients may complain of fever and malaise
    • It may be asymptomatic and in less than 24 hours, extensive lesions of oral mucosa may appear
    • It is characterized by a macule or papule, 0,5 to 2 cm in diameter
    • Typical skin lesions may be non-specific macules, papules, and vesicles
  • Toxic epidermal necrolysis
  • It occurs secondary to a drug reaction
  • It results in the sloughing of skin and mucosa in large sheets
  • It is common in females
  • It appears as if the patient is badly scalded
  • Oral manifestation
  • Site: lip, buccal mucosa, palate, tongue, and face
  • Presentation
  • It starts as bullae on the erythematous base and breaks into ulcers
  • The patient cannot eat or swallow and blood-stained saliva drools
  • The lesions are larger, irregular, deeper, and often bleed very freely
  • Healing occurs in 2 weeks

Erythema Multiforme Management:

  • Topical steroid
  • Removal of the causative agent
  • The patient should be rehydrated along with a soft diet intake
  • Topical anesthetic mouthwash to relieve pain
  • Systemic steroid: 30 mg/day prednisone for several days should be given
  • Acyclovir: if the lesion is associated with HSV
  • The patient is managed in burn centers

Question 2. Enumerate autoimmune diseases. Give clinical features and investigations of pemphigus vulgaris.

Answer:

Autoimmune Disorders:

  • Associated with mucocutaneous lesions
    • Recurrent aphthous ulcer
    • Behcet’s disease
    • Pemphigus
  • Salivary gland
    • Mikulicz’s disease
    • Sjogren’s syndrome
  • Blood disorder
    • Pernicious anemia
    • Purpura
  • Collagen disorder
    • Systemic lupus erythematous
    • Scleroderma
    • Rheumatic arthritis
  • Miscellaneous
    • Myasthenia gravis
    • Oral submucous fibrosis
  • Pemphigus

pemphigus vulgaris Clinical Features:

  • Age and sex: it is common In females 40-70 years of age
  • It represents rapidly developing vesicles or bullae on several areas of the skin and mucous membrane which contains clear fluid initially, but later on, there is the formation of pus
  • The vesicles or bullae rupture leaving painful ulcers
  • On oblique pressure, there is the stripping of normal mucosa
  • The disease involves the entire body
  • The patient’s condition becomes as serious as a severely burnt patient due to fluid loss and risk of secondary infections
  • Patients may even die due to septicemia
  • Skin lesions heal with scar formation while mucosal lesions without scar formation
  • Vesicles rupture resulting in ulcer
  • Ulcers are covered with blood-tinged exudates
  • They are painful
  • It may lead to excessive salivation and bleeding
  • The patient may have difficulty taking food
  • The patient may experience an extremely bad smell from the mouth.

Oral Medicine Dermatological Diseases

Pemphigus Vulgaris Investigations:

  • Tzanck smear:

Rub the lesion surrounding the area
↓
Puncture the lesion
↓
Absorb the secretion over cotton
↓
Collect this overslide and stain it
↓
Observe under microscope

Result: lesion shows acantholysis

Indirect immunofluorescent antibody test:

  • Antibodies against intercellular substances are seen

Direct test:

Antibody bind will) the inuminoglobln deposits hi the in
Tercellular substance
↓
Shows fluorescence

Question 3. Discuss etiology, clinical features, differential diagnosis, Investigations, and management of pemphigus vulgaris.

Answer:

Pemphigus Vulgaris Etiology:

  • Pemphigus

Pemphigus Vulgaris Clinical Features:

  • Age and sex: it is common in females 40-70 years of age
  • It represents rapidly developing vesicles or bullae on several areas of the skin and mucous membrane which contains clear fluid initially, but later on, there is forma¬tion of pus
  • The vesicles or bullae rupture leaving painful ulcers
  • On oblique pressure, there is the stripping of normal mucosa
  • The disease Involves the entire body
  • The patient’s condition becomes as serious as a severely burnt patient due to fluid loss and risk of secondary infections
  • The patient may even die due to Septicemia
  • Skin lesions heal with scar formation while marocain lesions without tear formation
  • Vesldes rupture resulting in an ulcer
  • Ulcers are covered with blood-tinged exudates
  • They are painful
  • It may lead to excessive salivation and bleeding
  • The patient may have difficulty taking food
  • The patient may experience extreme;/ bed cm eh from ore mouth

Pemphigus Vulgaris Differential Diagnosis:

  • Dermatitis herpetiformis
  • Erythema multiform
  • EuJIouc lichen planus
  • Epidermolysis bullosa
  • Bullous pemphigoid
  • Cicatricial pemphigoid

Pemphigus Vulgaris Management:

  • Aim:
    • Decrease blister formation
    • Promote healing
    • Determine a minimal dose of medication
    • Control disease process
    • Drugs used
    • High dose of steroids
    • Use of immunosuppressive drugs
    • Antibiotics – to prevent secondary infection
    • Maintain fluid and electrolyte balance

Question 4.  Write clinical features, investigations, differential diagnosis, sis, and management of herpetic gingivostomatitis.

Answer:

Herpetic Gingivostomatitis Clinical Features:

  • Age – occurs during childhood
  • Headache
  • Fever
  • Nausea, anorexia
  • Lack of tactile and sensory sensation
  • Sore throat
  • Drooling of saliva
  • Bilateral cervical lymphadenopathy
  • Irritability
  • Myalgia
    • Site involved
    • Gingiva
    • Hard palate
    • Dorsum of tongue
    • Lips
    • Vermillion border
    • Perioral skin
    • Nasopharynx
  • Reddening of oral mucosa
  • Formation of numerous small, dome-shaped or pin¬head type vesicle
  • Size – 2-3 mm diameter
  • Vesicles contain clear fluid and rupture to form ulcers
  • Ulcers are multiple, small, circular, punctuate, shallow, and painful
  • Have red margins and yellowish or greyish floor
  • Small ulcers fuse to form diffuse, large, whitish ulcers
  • They are surrounded by a red halo
  • Gingival margins are red, swollen, and painful and have punched-out erosions
  • Difficulty in taking food
  • Difficulty in mastication
  • Difficulty in swallowing
  • Numerous vesicle formations over the tonsillar area and posterior pharynx

Herpetic Gingivostomatitis Investigations:

  • Patient history
  • Clinical findings
  • Direct smear
    • The material is obtained from the base of the lesion and smeared and stained
    • The finding of multinucleated cells with swelling, ballooning, and degeneration is adequate for the diagnosis
    • Inoculation of the virus from a suspected site to tis¬sue culture.
  • Serological studies

Herpetic Gingivostomatitis Differential Diagnosis:

  • Drug-induced pemphigus – related to drug
  • ANUG – has a bacterial origin

Herpetic Gingivostomatitis Management:

1. Local applications:

  • Using 8% zinc chloride, Talbot’s iodine, phenol, riboflavin, thiamine, etc.
  • Chlortetracycline used as a mouthwash

2. Palliative treatment:

  • Plaque, food debris, and superficial calculus are removed
  • Relief in pain is obtained with dyclonine hydrochlo¬ride

3. Supportive treatment:

  • Copious fluid intake and systemic antibiotic therapy i.e. aspirin is administered

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