This document discusses oral ulcers caused by various infectious and non-infectious conditions. It describes the clinical features and management of several specific conditions that can cause oral ulcers, including herpes simplex virus infections (primary and recurrent), varicella-zoster virus infections (chickenpox, herpes zoster), hand-foot-and-mouth disease, herpangina, tuberculosis, and syphilis. For each condition, it covers the presentation of oral ulcers, pathogenesis, diagnosis, and treatment approaches.
Erythema multiforme, Steven-Johnson syndrome and Toxic Epidermal NecrolysisBinaya Subedi
Erythema Multiforme is a common Vesiculobullous deramtological condition with mucosal manifestations trigged by Herpes virus infection and certain sulpha containing drugs.
describes the etiopathogenesis , clinical features, investigations, differential diagnosis and management and prophylaxis of all important viral lesions affecting the oral cavity
Not only the lesions in the body helps us to know about syphilis but also a minute nodule or lesion helps us to discover the syphilis. He who knows syphilis knows the medicine well. Earlier you found the disease the treatment and the prognosis will be good. Discover syphilis through your body's gateway.
Erythema multiforme, Steven-Johnson syndrome and Toxic Epidermal NecrolysisBinaya Subedi
Erythema Multiforme is a common Vesiculobullous deramtological condition with mucosal manifestations trigged by Herpes virus infection and certain sulpha containing drugs.
describes the etiopathogenesis , clinical features, investigations, differential diagnosis and management and prophylaxis of all important viral lesions affecting the oral cavity
Not only the lesions in the body helps us to know about syphilis but also a minute nodule or lesion helps us to discover the syphilis. He who knows syphilis knows the medicine well. Earlier you found the disease the treatment and the prognosis will be good. Discover syphilis through your body's gateway.
Cold sores are caused by a contagious virus called herpes simplex. There are two types of herpes simplex virus. Type 1 usually causes oral herpes, or cold sores. Type 1 herpes virus infects more than half of the U.S. population by the time they reach their 20s. Type 2 usually affects the genital area.
This Presentation will help ou to compare the spectrum of pathologies in ulcerated versus non-ulcerated exophytic oral mucosal lesions and explore the significance of surface ulceration as an indication of various oral diseases
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. ULCER= defect or break in the continuity of
the epithelial component of skin or mucosa,
so that a depression or punched out area
exists with exposure of the underlying
.connective tissue
3. Important Causes of Oral
:Mucosal Ulcers
Vesiculo-Bullous Diseases:
Infective
• Primary and recurrent Herpes simplex.
• Herpes zoster and chickenpox
• Hand-foot-and - mouth disease
• Herpangina
9. :Clinical Features
Incidence : Children 2-10 years old
Non-immune adults
Infection is unexpected below 6 months
of age due to presence of maternal
antibodies gained by the enfant during
intrauterine life.
10. Prodrome
Fever, headache, malaise, lymphadenitis,
nausea and vomiting. These precede the
appearance of oral vesicles by 1-2 days.
The early lesions: vesicles 2-3 mm in
diameter. Rupture of vesicles leaves circular,
sharply defined, shallow ulcers with yellowish
or grayish floors and red margins. The ulcers
are painful and may interfere with eating.
11. The gingival margins: are frequently
swollen and red, particularly in children.
Sometimes labial and facial lesions
appear without intraoral involvement.
Oral lesions usually resolve within a
week to ten days (Self-limiting).
13. :Diagnosis
1-History:
History of prodromal symptoms 1-2 days
before oral lesions
Negative history of recurrent herpes
labialis
Positive history of contact with a patient
with primary or recurrent lesions.
14. 2-The clinical picture
3-Lab investigations:
A smear showing virus-damaged cells
A rising titre of antibodies reaching a peak
after 2-3 weeks provides absolute but
retrospective confirmation of the
diagnosis.
15. Treatment
Supportive measures sometimes are all that is
needed .
Acyclovir is a potent antiherpetic drug. It inhibits
DNA replication in HSV-infected cells but has no
effect on normal cells.
Dose: adult: 200 mg 5 times/day (5 days)
Children: 100 mg 5 times /day (5 days)
16. Recurrent Herpes Simplex
:Lesions
Due to reactivation of latent virus residing
in cells after a previous primary attack (not
a re-infection)
A) Recurrent Herpes Labialis
B) Recurrent Intra oral Herpes
17. :A) Recurrent Herpes Labialis
Prodromal paraesthesia
or burning sensations
then erythema.
Vesicles form after an
hour or two usually in
clusters along the
mucocutaneous
junction of the lips but
can extend onto the
adjacent skin.
18. The vesicles enlarge, coalesce and weep
exudates.
After two or three days they rupture and
crust over
Finally heal, usually without scarring. The
whole cycle may take up to 10 days.
Secondary bacterial infection may change
the lesions into pustules
19. :B) Recurrent Intra oral Herpes
Clusters of small
vesicles that break
into ulcers, 1-2
mm in diameter,
appear mainly on
keratinized oral
mucosa (gingival,
hard palate, …).
20. Treatment
Treatment must start as soon as the
premonitory sensations are felt.
Acyclovir cream may be effective if
applied at this time.
21. Chronic Herpes Simplex
:Lesions
It is a variant of recurrent herpes simplex lesion
occurring in immunocompromised patients
(AIDS, immunosuppressive therapy, leukaemia,
lymphoma, …..)
Lesions appear on skin or mucosal surfaces as
an ordinary recurrent herpetic lesion but: remain
for weeks or months and develop into large
ulcers (up to several centimeters in diameter).
23. :Herpetic Cross-infections
Both primary and secondary herpetic infections
are contagious.
Herpetic whitlow, which is an infection of fingers
after manipulation of herpetic lesions, is a hazard
to dental surgeons and their assistants.
Herpetic whitlows, in turn, can infect patients
In immunodeficient patients such infections can be
dangerous but acyclovir has dramatically improved
the prognosis in such cases .
Mothers applying antiherpetic drugs to children’s
lesions should wear gloves.
26. :A) Chicken Pox
A childhood disease
characterized by:
Mild systemic symptoms.
Generalized pruritic
eruption of
maculopapular lesions
that rapidly develop into
vesicles on
erythematous base.
Oral vesicles that rapidly
rupture giving ulcers.
27. B)Herpes zoster
:(1)The trigeminal area
Recurrence of VZV infection occurs typically
in the elderly
Pain precedes the rash (prodrome)
Facial rash accompanies the stomatitis
Lesions are localized to one side (absolutely
unilateral), within the distribution of any of the
divisions of the trigeminal nerve
Malaise can be severe
28. Sometimes pain occurs without rash or
oral lesions, (herpes sine eruption) which
leads to problems in diagnosis.
31. Pathology
The varicella zoster virus produces similar
epithelial lesions to those of herpes
simplex, in addition to inflammation of the
related posterior root ganglion.
32. Complications
Sometimes followed by post-herpetic
neuralgia, particularly in the elderly.
Can be life-threatening in
immunocompromised patients.
Secondary infection may cause
suppuration and scarring of the skin.
When the ophthalmic division is involved,
blindness due to corneal scarring may
occur
33. Treatment
Oral acyclovir (800 mg five times daily, usually for 7
days) as early as possible.
Intravenous acyclovir :In immunodeficient patients.
Analgesics.
The addition of prednisolone (corticosteroids) may
accelerate relief of pain and healing and prevent postherpetic neuralgia in elderly patients.
37. Hand-foot-and-mouth Disease
Common mild viral infection
Causes minor epidemics among school
children
Characterized by ulceration of the mouth
and a vesicular rash on the extremities.
Caused by strains of Coxsackie A virus.
The incubation period is 3-10 days.
38. Clinical Features
Small scattered oral ulcers usually with little
pain.
Intact vesicles are rarely seen
Gingivitis is not a feature.
Regional lymph nodes are not usually enlarged
and systemic upset is mild or absent.
The skin rash consists of vesicles, sometimes
deep-seated, or occasionally bullae, mainly seen
around the base of fingers or toes, but any part
of the limbs may be affected.
41. Herpangina
Coxsackie virus A infection (usually A4).
Children 3-10 years are mostly affected (but
other ages are possible).
Frequently occurs in epidemics.
42. Clinical Features
Incubation period: 2-10 days
Prodrome: fever, chills, anorexia, sore throat,
dysphagia
Lesions (soft palate, tonsils, pharynx):
macules → papules and vesicles → small (12 mm) ulcers.
Ulcers heal without treatment in about 7 days.
44. Tuberculosis
Ulcer on the mid-dorsum or tip of the
tongue; the lip or other parts of the
mouth are infrequently affected.
The ulcer is typically angular with overhanging edges and a pale floor, but can
be ragged and irregular.
Ulcer is painless in its early stages
regional lymph nodes are usually
unaffected.
47. Treatment
Oral lesions clear up rapidly if vigorous
multi-drug chemotherapy is given for the
pulmonary infection. No local treatment is
needed.
48. Syphilis
Primary Syphilis:
An oral chancre appears 3-4 weeks after infection on the
lip, tip of the tongue or rarely, other oral sites.
It consists initially of a firm nodule about a centimeter
across. The surface breaks down after a few days, leaving
a rounded ulcer with raised indurated edges.
A chancre is typically painless but regional lymph nodes
are enlarged, rubbery and discrete.
Serological reactions are negative at first.
Treponema pallidum can be demonstrated by darkground illumination of a smear from the chancre.
Oral chancres are highly infective.
After eight or nine weeks the chancre heals, often without
scarring
49. Secondary Syphilis:
Develops 1-4 months after infection.
Mild fever with malaise, headache, sore throat and
generalized lymphadenopathy, soon followed by a rash
and stomatitis.
The rash consists of asymptomatic pinkish (coppery)
macules, symmetrically distributed and starting on the
trunk. It may last for a few hours or weeks
Oral lesions, which rarely appear without the rash, mainly
affect the tonsils, lateral borders of the tongue and lips.
They are usually flat ulcers covered by grayish membrane
and may be irregularly linear (snail track ulcers) or
coalesce to form well-defined rounded areas (mucous
patches).
Discharge from the ulcers contains many spirochaetes
and saliva is highly infective.
Serological reactions are positive and diagnostic at this
stage.
50.
51.
52. Tertiary Syphilis:
Develops in many patients about three or more
years after infection.
A characteristic lesion is the gumma.
Clinically, a gumma, which may affect the
palate, tongue or tonsils can vary from one to
several inches in diameter.
It begins as a swelling, sometimes with a
yellowish centre which undergoes necrosis,
leaving a painless deep ulcer. The ulcer is
rounded, with soft, punched-out edges. The floor
is depressed and pale.
It eventually heals with severe scarring which
may distort the soft palate or tongue, perforate
the hard palate or destroy the uvula.
57. Clinical Picture
Lesions are confined to oral mucosa ( no
extraoral manifestations).
Prodrome: burning sensation (2-48
hours) with the appearance of localized
erythema
Ulceration: single or multiple ulcers
appear within few hours. Ulcers are
surrounded by erythema and painful. No
tissue tags surround the ulcers.
58. Healing: in minor form it takes 7-14 days,
in major ulcers it may take several
months. No scar formation occurs except
in major form.
Healing is characterized by
disappearance of the surrounding
erythema.
60. Treatment
In cases with underlying systemic
disease : remedy the cause
For minor aphthae: treatment is related
to the severity.
61. In mild cases:
Protective topical treatment as orabase
Topical anaesthetic
Non-steroidal anti-inflammatory
Benzydamine hydrochloride mouth wash.
In more severe cases:
Potent topical steroid asTriamcinolone
dental paste
62. Treatment of major aphthae.
Effective treatments include
Systemic or intralesional steroids,
Azathioprine,
Cyclosporine
Colchicines and
Dapsone.
63. Tetracycline mouth rinses. For
herpetiform aphthae particularly .
Chlorhexidine. A 0.2% solution has also
been used as a mouth rinse for aphthae.
64. Behcet's Disease
Behcet's syndrome was originally defined
as a triad of oral aphthae, genital
ulceration and uveitis. However, it is a
multisystem disorder with varied
manifestations.
Patients are usually young adult males
between 20 and 40 years old.
65. Patients suffer one of four patterns of disease:
Mucocutaneous (oral and genital ulceration)
Arthritic (joint involvement with or without
mucocutaneous involvement)
Neurological (with or without other features)
Ocular (with or without other features).
The oral aphthae of Behcet's disease are not
distinguishable from common aphthae. They are
the most consistently found feature and
frequently the first manifestation.
66. Diagnosis
Pathergy Test:
The test is positive if there is an
exaggerated response to a sterile needle
puncture of the skin, where such puncture
is followed by pustule formation.
67. Diagnostic criteria for Behcet's
disease
Major Criteria
Recurrent oral aphthae
Genital ulceration
Eye lesions (uveitis, retinal vasculitiz )
Skin lesions(Erythema nodosum, subcutaneous
thrombophlebitis, hyperirritability of the skin +ve
pathergy test)
68. Minor Criteria
Arthralgia or arthritis
Gastrointestinal lesions
Vascular lesions (mainly thrombotic)
Central nervous system involvement
69. Treatment
No specific treatment, but oral lesions can be
controlled by:
Topical or intralesional corticosteroids
Topical anaesthesia to alleviate pain
Systemic corticosteroids in resistant cases
(40-60 mg prednisone/day).
Combination of steroid and immunosuppressive
drugs (e.g. azathioprine).
70. Reiter’s Syndrome
A triad of urethritis, arthritis and conjunctivitis.
Oral manifestations:
Painless circinate white lesions that may
ulcerate giving aphthous-like ulcers.
Geographic tongue like lesions
Purpuric rash in palate
72. Erythema Multiforme
This is an acute inflammatory
mucocutaneous disease but among dental
patients oral lesions are the most
prominent or the only ones present
73. Aetiology
Infections, particularly herpetic can be
triggering factors.
Drugs, particularly sulphonamides and
barbiturates.
In most patients no precipitating cause
can be found.
74. The histological appearance
Intraepithelial or subepithelial vesicle or
bulla formation due to widespread
necrosis of keratinocytes
Infiltration by inflammatory cells which
also involve the corium and may have a
perivascular distribution.
80. Typical cases show at least some target (or iris)
lesions. A typical target lesion is less than 3 cm
in diameter, rounded, and has three zones: a
central area of dusky erythema or purpura, a
middlepaler zone of oedema and an outer ring of
erythema with a well-defined edge.
Atypical target lesions have only two of the
zones
The kobner phenomenon
81. Localized vesiculobullous form
This form is intermediate in severity. The
skin lesions present as erythematous
macules or plaques, often with a central
bulla and a marginal ring of vesicles.
Mucous membranes are quite often
involved.
83. The onset is usually sudden
There may be a prodromal systemic
illness of 1-13 days before the eruption
appears.
Numerous organs are affected, changes
were found with the following frequency:
mouth 100% eyes, skin, male genitalia,
anal mucous membrane, bronchitis and
pneumonitis.
85. :Pemphigus Vulgaris
Pemphigus is an uncommon autoimmune
disease causing vesicles or bullae on skin
and mucous membranes. It is usually fatal
if untreated
86. :Clinical Features
Females aged 40-60 years are predominantly affected.
Lesions often first appear in the mouth but spread widely
on the skin.
Vesicles are fragile . Residual erosions often have
ragged edges and are superficial, painful and tender.
Positive Nikolsky's sign.
Oral lesions show lack of inflammatory signs unless
secondary infection occurs.
Extension of lesions to the vermilion border may lead to
the formation of a crusted lesion.
87.
88.
89. :Pathology
Intra epithelial vesicles and bullae are
formed. Lesions result from the
destruction of desmosomal junction
between prickle cells and basal cells due
to the presence of autoantibodies against
desmoglein 3 which is an attachment
molecule in desmosomes.
90. Management
Diagnosis is confirmed by direct
immunofluorescence and by the demonstration
of circulating autoantibodies.
60-100 mg/day of predisolone alone or in
addition to azathioprine (1-1.5 mg/kg daily).
Azathioprine is given to allow doses of the
conrticosteroid to be lowered and reduce their
side-effects. Intralesional steroid application may
help.
91. Mucous Membrane (Cicatricial)
:Pemphigoid
Mucous membrane pemphiogoid is an
uncommon chronic disease causing bullae and
painful erosions.
Skin involvement is uncommon and often trivial.
In stead, mucous membranes all over the body
are affected. The term cicatricial pemphigoid is
sometimes used for this group of disease, but
particularly applies to ocular involvement where
scarring is prominent and impairs sight.
92. :Desquamative Gingivitis
The term desquamative gingivitis is a
clinical description, not a diagnosis. It is
used for conditions in which the gingivae
appear red or raw. Usually the whole of
the attached gingival of varying numbers
of teeth is affected
93. :Oral Reactions to Drugs
Many drugs can occasionally cause oral
reactions. They are varied in type but
frequently lichenoid or ulcerative. The
mechanisms of reactions to drugs are
often obscure
Editor's Notes
Mucocutaneous (oral and genital ulceration)
Arthritic (joint involvement with or without mucocutaneous involvement)