This presentation will will give you the idea of a dermatological disoders with clinicopathological features. A vesiculobullous disease is a type of mucocutaneous disease characterized by vesicles and bullae (i.e. blisters).

1. M I S B A H N A S I M
3 R D Y E A R B D S
Vesiculobullous Disease.
ِ‫ن‬ ٰ‫م‬ْ‫ح‬َّ‫الر‬ ِ‫هللا‬ ِ‫م‬ْ‫س‬ِ‫ب‬
ِ‫ْم‬‫ي‬ ِ‫ح‬َّ‫الر‬

2. Vesicubullous disease
Vesicle & Bulla
 A clear fluid lesion just below the epithelium which
ruptures to form an ulcer.
 If the lesion is smaller than 5mm than it is vesicle.
 If larger than 5mm than it is a bulla.

4. Classification

5. Intraepithelial Vesiculobullous disease
IVD can be further subdivide into two groups
depending on the mechanism of formation of the
lesion
 Acantholytic vesicles or bullae,
The lesions are produced by breakdown of intercellular attachment
(desmosomes) between epithelial cells.
 Non-acantholytic vesicles or bullae,
The lesions are produced by death and rupture of groups of epithelial
cells.

6. Phemphigus Vulgaris
 Autoimmune disease.
 Most common in middle-aged Females.
Clinical Features
 Characterized by fluid-filled bullae eruptions involving the
skin and mucous membrane.
 These bullae are fragile and ruptures forming crusted or
weeping areas of denudation on the skin or mucosal ulcers.
 Nikolsky’s sign positive.
 LOCATION: Most affected areas are Soft palate, Buccal
mucosa & Lips.

7. Phemphigus vulgaris

8. Histopathology
 Intraepithelial cleft like spaces are produced by
acantholysis.
 The changes occur in stratum spinosum and basal cell
layer.
 Unlike normal polyhedral stratum spinosum cells are small
rounded and contain enlarged hyperchromatic nuclie
(tzanck cells).
 In basal layer the cell project into the bulla like a row of
tombstones.
 Inflammatory cells are scanty however eosinophil may be
seen.

9. Histopathology

10. Diagnosis
 Biopsy of perilesional mucosa.
 Direct immunofluroscent techniques.
 ELISA.

11. Classification

12. Erythema multiforme
 Mucocutaneous disease.
 Gender: Mostly in males.
 Age: Early middle age.
 Appearance: target like lesions.

13. Appearance & Aetiology

14. Clinical features
 Location: skin, oral, genital, and
ocular mucosa.
 Mucosal vesicles/oral ulceration.
 Concentric rings with centric
crusted bulla.
 Erosion on the lips are
accompanied by bleeding and
crusting.
 Ocular mucosa -> conjunctival
scarring & visual impairment.

15. Histopathology
 Necrosis of keratinocytes and vesicle formation
 Infiltration of inflammatory cells.
 Oedamatous epithelium and varying degree of
cellular damage.

16. Histopathology

17. Pemphigoid
 Autoimmune vesiculobullous disease.
 Affects skin and oral mucosa.
 Characterized by the formation of bulla.
Subdivides into two groups
1. Bullous pemhigoid:
lesions involving skin alone with only minimal mucosal
involvment.
2. Mucous membrane pemphigoid:
lesions involving mucosa alone with only minimal skin
involvment.

18. Bullous pemphigoid Mucous membrane pemphigoid
Pemphigoid

19. Mucous membrane pemphigoid
 Also called cicatrical phemphigoid.
 More common in elderly females.
Characteristics
 Bullae are tense, relatively tough and may remain intact for
a few days.
 When they ruptures -> give rise to erosion which heals
slowly with scarring.
 In addition to oral mucosa, the conjunctiva and mucosa of
nose, larynx, pharnyx, oesophagus and genitals may
involved.

20. Dermatitis herpetiformis
 Oral manifestations are
variable & range from
small symptomless
erythematous areas to
extensive erosion.
 90% of patients have
abnormality of their jejunal
mucosa associated with
gluten hypersensitivity.

21. Linear IgA
 Rare subepithelial blistering
disease of the skin.
 Patients may have gluten
hypersensitivty.

22. Erythema bullosa acquisita

23. Hereditary disease
Epidermolysis bullosa Angina bullosa haemorrhagica

24. Epidermolysis bullosa
 Cause: Gene mutations resulting in intraepithelial
and subepithelial bullae.
 Extreme fragility of skin.
 Develops in response to minimal trauma or pressure.
 Claw like deformity.
 Difficulties in eating, speaking and swalloing because
of the involvment of mouth, larynx and pharynx.

25. Epidermolysis bullosa

26. Angina bullosa Haemorrhagica
 Blood filled bullae (blisters).
 Middle aged or elderly.
 2-3 cm in diameter.
 Location: soft palate &
Buccal mucosa.
 Early perforation -> ulcer.

27. Reference
 Oral pathology by J.V Soames.
 Images from google.