Diseases of skin 3./ dental implant courses

DISEASES
OF
THE SKIN
PEMPHIGOID,
ERYTHEMA MULTIFORME
INDIAN DENTAL ACADEMY
LEADER IN CONTINUING DENTAL
EDUCATION
www.indiandentalacademy.com

LEARNING OBJECTIVES
At the end of the lecture student should beAt the end of the lecture student should be
able toable to describe thethe
 Clinical features, Oral manifestations,&
Histopathological features of Pemphigoid, Erythema
Multiforme

PEMPHIGOID
•Pemphigoid is a relatively
uncommon vesiculobullous lesion,
characterized histologically by the
subepithelial bullae formation in the
basement membrane zone.
•Pemphigoid Clinically similar to
Pemphigus (Oid=similar) BUT
histologic features & prognosis is
different.

PATHOGENESIS
 Formation of
autoantibodies in the body
against the antigenic
components of the
basement membrane zone
 Binding of autoantibodies
to hemi-desmosome
associated antigens in the
basement membrane.

Activation of complements
Synthesis of chemotactic factors
Release of proteolytic enzymes.
Destruction of hemidesmosomal junctions of
the basement membrane zone.
Formation of subepithelial vesicle or bullae.

 Unlike pemphigus, pemphigoid lesions usually
heal up by Scar formation (Cicatrication)
A.Cicatricial Pemphigoid
B.Bullous Pemphigoid
 Cicatricial Pemphigoid, in relation to the
mucous membrane, while Bullous
Pemphigoid occurs frequently in relation to
the skin.

CICATRICIAL PEMPHIGOID (Benign Mucous
Membrane Pemphigoid (BMMP)
CLINICAL FEATURES
 It frequently affects the middle-aged or elderly
females.
 The most common site of occurrence is the
OMM, followed by the conjunctiva.
 Sometimes the disease also involves the nose,
pharynx, larynx, esophagus and genitalia, etc.

ORAL LESIONS
 Oral lesions begin as either vesicles or
bullae, most commonly involving gingiva.
 In severe cases, large vesicles or bullae
may develop on the palate, cheek, alveolar
mucosa or tongue, etc.

 Bullae are sometimes quite large in size and they
persist for several days.
 Gingival lesions often show erosion &
desquamation after rupture of bullae & leave raw
eroded, bleeding surface even for weeks or
months.
(Chronic Desquamative Gingivitis)

 The mucosal bullae are often tense and are
relatively tough because these are usually
covered by a full thickness epithelium, more
over, these lesions remain intact for several
days
 Pain and bleeding are the common complaints
and Nikolsky's sign is positive

Adhesions (symblepharons) between
the bulbar & palpebral conjunctivae
Upper eyelid turns inward ( entropion)
resulting in eyelashes rubbing against
the eye (trichiasis)
Severe conjunctivitis, lower eyelashes
are removed because of trichiasis
Complete scarring between
conjunctival mucosa & eyelids
resulting in blindness)

Eye Lesions
 Conjunctivitis
 Blister formation in the eye
 Corneal ulcerationthat often leads to blindness
 Swelling of the fornix and corneal opacity.
 Fibrosis and scarring of the lacrimal ducts, which
often leads to "dry eye".
 Scarring may cause adhesions between the bulbar
and the palpebral conjunctiva.

SKIN LESIONS
 Skin lesions occur in
about 5% cases and
mucosal lesions always
precede the skin lesions
 There are tense, fluid
filled vesicles or bullae
which may appear over
the face, scalp or neck.

BULLOUS PEMPHIGOID
 Occurs more commonly on the skin, seldom affects
the oral mucosa.
CLINICAL FEATURES
 These lesions also follow the usual clinical patterns of
vesiculation, followed by ulceration and finally healing
(without scarring).
 Elderly people in the age group 70 to 80 years are
usually affected, and there is no gender predilection.

 The skin lesions mostly occur over the trun(.
and limbs, and usually undergo spontaneous
regression.
 Skin lesions begin as red, eczematous plaques
which eventually progress to the formation of
bullae.
 Skin lesions always precede the mucosal lesions
and these mucosal lesions are always smaller
than that of the cicatricial pemphigoid.
 Bullous pemphigoid having oral lesions may be
associated with internal malignancy

HISTOPATHOLOGY
 Extracellular edema and vacuolation in the basement
membrane zone are the earliest histological changes
in cicatricial pemphigoid.
 Gradually there is formation of sub epithelial vesicles
or bullae.
 The sub epithelial bullae cause separation of the full
thickness epithelium from the underlying lamina
propria.

 Acantholysis and epithelial degenerative
changes are absent.
 Polymorphonuclear neutrophils (PMN) may be
found within the vesicular fluid.
 Blood vessels are often dilated and prominent
in the superficial part of the lamina propria.

 Subepithelial connective
tissue shows inflammatory
cell infiltration by
lymphocytes, macrophages &
eosinophils in the
perivascular areas.

ERYTHEMA MULTIFORME
•Erythema multiforme is an acute
inflammatory dermatological disorder
that frequently involves skin, mucous
membrane and sometimes the
internal organs.
•Characterized by presence of
Iris /Target lesions

 Two forms-
1. EM minor-localized eruption of skin with
mild or no mucosal involvement
2. EM Major ( Stevens-Johnson syndrome)-
more severe (potentially life threating)
skin & mucosal involvement

ETIOLOGY
1. Infections: Tuberculosis, Herpes simplex (I
and II)
Infectious mononucleosis, Histoplasmosis,
1. Drug Hypersensitivity:
Barbiturates,Sulfonamides, Phenylbutazone,
Salicylates, Oral pills, etc.
2. Hyperimmune Reactions
3. Miscellaneous Factor: Radiation therapy,
Crohn'sdisease, Vaccinations

CLINICAL FEATURES
 Frequently occurs between the age of 15 & 40
years
 Males > females.
 Rapidly developing erythematous macules,
papules, vesicles or bullae, often appear
symmetrically over the hands, arms, legs, feet,
face, neck
 The classic dermal lesions of erythema
multiforme which often appear on the extremities
are called "Target", "Iris" or "Bull's eye"

 Dermal lesions consist of
concentric erythematous
rings separated by rings of
near normal color on the
skin.
 Mucosal lesions of this
disease also consist of
macules, papules or
vesicles, etc. & mostly seen
on the tongue, palate,
buccal mucosa & gingiva.
Bulls eye lesion

 The vesicles of the
mucosal surfaces are
often short-lived and
they readily become
eroded or ulcerated &
bleed profusely.
 The ulcers are extremely
painful & are normally
covered by a slough;
they can be secondarily
infected in may cases
too.
Ulcerated lesions
Hemorrhagic crusts on lips

 Foul smell in the mouth & difficulty in eating &
swallowing
 The cutaneous & mucosal lesions may occur
either separately or simultaneously.
 Tracheo-bronchial ulcerations & pneumonia
 Uncommon among children & older individuals,
however, if it occurs in the older people, the
possibility of an internal carcinoma should not be
ruled out.

Introduction, Clinical features, Oral
manifestations,& Histopathological features
of Pemphigoid, Erythema Multiforme

BIBLIOGRAPHY
 Text book of oral pathology Shafer's, 5 & 6th
edition
 Oral & Maxillofacial Pathology A Rationale for
Diagnosis & Treatment. R E Marx 1st
edition
 Color Atlas of Oral Diseases Cawson, R. 2nd
& 5th
edition
 Oral and Maxillofacial Pathology Neville, Brad
W. 2nd
 Lucas’s Pathology Of Tumor’s of the Oral Tissues
 Robbins Basic Pathology, Kumar V, A Fausto, 8th
edition
 Lever’s Histopathology of the skin, David Elder
8th
edition

Diseases of skin 3./ dental implant courses

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (11)

Similar to Diseases of skin 3./ dental implant courses

Similar to Diseases of skin 3./ dental implant courses (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Diseases of skin 3./ dental implant courses