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Vesiculo-Bullous Lesions, : - Coggle Diagram

- - - - Intraoral/perioral: In most cases, oral lesions are the first indication of PV. They can be found on any epithelial surface including the skin, oral cavity, esophagus, larynx, pharynx, vagina, anus, and eyes. Lesions can be very painful. Burkhart, Delong. pp 262
      - Distinguishing: Nikolsky sign is usually positive in affected patients. Which means the clinician can initiate bulla formation by stretching or rubbing the mucosa in a clinically unaffected area.
        Burkhart, Delong. pp 262
      - Extraoral: Lesions begin as bullae that rupture quickly, forming ulcers covered by a gray pseudomembrane. When removed, it uncovers an erythematous surface. If untreated, lesions persist and enlarge.
        Burkhart, Delong. pp 262
      - Significant Microscopic Feats: Acantholysis with free floating, rounded epithelial cells called Tzanck cells are characteristic. Basal cells may have a tombstone like appearance.
        Burkhart, Delong. pp 262
  - - - Characteristics
        
        Intraoral/perioral: The oral cavity is most frequently involved. localized or generalized desquamative gingivitis is present 90% of the time. Gingiva is highly friable.
        Burkhart, Delong. pp 264
        
        Distinguishing: Lesions are confined to gingiva 50% of the time. A positive Nikolsky sign is usually present. eye lesions are common. Scarring and symblepharon may occur.
        Burkhart, Delong. pp 264
        
        Extraoral: Over 80% of cases involve the oral mucosa followed by the conjunctiva being the next most common site. Localized skin bulla occasionally occur. Lesions may also be found on the skin, nares, rectum, urethra, and esophagus. Bulla are short lived, breaking and leaving the raw erythematous or ulcerated surface.Scarring is a major factor of the disease.
        Burkhart, Delong. pp 264
        
        Significant Microscopic Feats: Subbasal layer separation of the epithelium from the underlying connective tissue is characteristic. Immunofluorescence is positive.
        Burkhart, Delong. pp 264-265
      - Dental Implications: N/A Burkhart, Delong. pp 264
      - Method of Transmission: MMP is ideopathic and classified as an autoimmune disease.
        Burkhart, Delong. pp 264
      - Treatment and Prognosis: Topical corticosteroids and intralesional injections are used when needed on a limited basis. Is not life threatening. Discontinue use of alcohol based mouthwash, spicy foods, cinnamon, and strong flavoring agents. Avoid toothpastes and mouth rinses that contain laurel sulfate.Perform a dietary analysis. Frequent maintenance visits are needed for those with desquamative gingivitis.
        Burkhart, Delong. pp 265
      - Etiology: When affecting the gingiva, the term desquamative gingivitis is used. IgG and IgA target subepithelial components of the basement membrane zone. Scarring and fibrosis result.Burkhart, Delong. pp 264
    - - Characteristics
        
        Introral/perioral: Relatively rare, affects the gingiva, Cutaneous bulla develop slowly and may last for weeks to months before breaking,creating painful erythematous and ulcerative lesions. Occur on the gingiva, palate, floor of the mouth, tongue, or buccal mucosa. Chronic. Healing usually occurs without scarring. Usuall affects the skin first.
        Burkhart, Delong. pp 266
        
        Distinguishing: None Burkhart, Delong. pp 266
        
        Extraoral: None
        Burkhart, Delong. pp 266
        
        Significant Microscopic Feats: Are similar to those of MMP.
        Burkhart, Delong. pp 266
      - Dental Implications: none Burkhart, Delong. pp 266
      - Method of Transmission: none Burkhart, Delong. pp 266
      - Treatment and Prognosis: Systemic corticosteroids alone or in combination with other immunosuppressive agents are required. Other treatment may include dapsone, cyclosporine, sulfapyridine, and niacinamide. Plaque control is beneficial, with frequent prophy. Discontinue use of alcohol products.
        Burkhart, Delong. pp 266
      - Etiology: Bullous Pemphigold is an autoimmune disease.
        Burkhart, Delong. pp 266
- - - - Characteristics:
        
        Extraoral: May be found in the oral or genital areas. Presents as multiple, painful ulcerations in the genital area. Clinically indistinguishable from each other. Burkhart, Delong. pp 251
        
        Intraoral/Perioral: classic feature is fiery red, marginal gingivitis that affects all areas of the dental arch. Multiple small vesicular lesions show up on the gingiva, tongue, lips, oral mucosa, and perioral skin. Burkhart, Delong. pp 251
        
        Distiguishing: Extreme pain, elevated temperature, general malaise. Cervical lymphadenopathy and a sore throat commonly occur. Signs and symptoms more severe in adults Burkhart, Delong. pp 251
        
        Significant Microscopic feats.: HSV exhibits intraepithelial vesicle formation. Cells appear as virus-infected epithelial cells with inflammatory cells and a ballooned, degenerating appearance with microscopic inclusions and multinucleation.
        Burkhart, Delong. pp 251
      - Dental implications: Treatment should be rescheduled until lesions have healed. Encourage patients to keep hydrated. Burkhart, Delong. pp 251
      - Method of transmission: Close physical contact such as kissing, sharing utensils, aerosols, and crowded living conditions Burkhart, Delong. pp 251
      - Treatment and Prognosis: Palliative treatment with a soft diet, nonacidic liquids, and noncarbonated beverages are encourage as well as cold foods. Acyclovir is helpful if taken within the first 3 days of the lesions. This is administered 5 times a day for 5 days by rinse and swallow technique. Anti-inflammatory drugs are helpful as well. Lesions usually resolve in 10-14 days.
        Burkhart, Delong. pp 252
      - Etiology: Common acquired during childhood and is caused by HHV-1 Burkhart, Delong. pp 250
    - - Characteristics
        
        Intraoral/perioral: Initially appear as clusters of vesicles on the vermillion border, perioral skin, or less commonly the keratinized intraoral surfaces. When on lips and perioral surfaces, it is known as herpes labialis. Lesions appear unilaterally. often referred to as cold sores when found on the lip. vesicles rupture quickly leaving ulcers that usually crust and heal within 7-14 days.
        Burkhart, Delong. pp 252-253
        
        Distinguishing: Often local, prodromal symptoms prior to a vesicle appearance such as burning, tingling, tissue warmth, itching or pain before any eruption.
        Burkhart, Delong. pp 253
        
        Extraoral: Cluster of vesicles are most likely but some scarring may be present due to extensive outbreaks.
        Burkhart, Delong. pp 252
        
        Significant Microscopic Feats.: Histology reveals ulceration with fibrin exudates and acantholytic epithelial cells.
        Burkhart, Delong. pp 253
      - Dental implications: Dental care should be postponed when lesions are present. Burkhart, Delong. pp 253
      - Method of transmission: Virus particles in the lesions can be transmitted through touch. Burkhart, Delong. pp 252
      - Treatment and Prognosis: Herpes Labialis antiviral, over-the-counter ointments or creams may reduce the duration and may stop some lesions from developing. Instruct patients to use a cotton tip applicator and rubber gloves to apply medicine. instruct patient to avoid sunlight when possible. Penciclovir allows increased absorption through the vermillion border and is best applied when the resurgence is in the early stages. Burkhart, Delong. pp 253
      - Etiology: Caused by reactivation of the latent virus of HSV-1. These lesions are also known as recrudescent HSV. Usually caused by a weakened immune system such as cold, fever, sunburn, emotional stress, trauma, pregnancy, infection. debilitation, menstruation, systemic disease, and possible allergies. Burkhart, Delong. pp 252
    - - Ocular Herpes: Usually caused by autoinoculation which means that someone has most likely transferred the infection from one part of their body to the eyes. can also be transferred through aerosols and splashes that occur during dental procedures. Burkhart, Delong. pp 254
      - Herpes Simplex Virus and Genital Herpes: This type is transferred through genital secretions. Increased likelihood of oral transmission due to the increase in oral sex practices. Burkhart, Delong. pp 254
      - Herpetic Whitlow: Occurs on a terminal segment of the finger.Can debilitate an individual for weeks. Usually occurs as a primary infect but cyclic recurrence has been described. Health care workers are susceptible especially those that work in the mouth. Burkhart, Delong. pp 253-254
    - - Characteristics
        
        Intraoral/Perioral: Cutaneous lesions may form on the head and neck. Vesicular intraoral lesions are usually found on the lips, hard palate, and buccal mucosa. lesions heal without scarring in most cases. Burkhart, Delong. pp 255
        
        Distinguishing: Presents with a wide range of symptoms, and the infection is often subclinical or may be a minor rash with some upper respiratory symptoms. Can be severe enough to hospitalize a patient to keep hydrated and body temperature normal.
        Burkhart, Delong. pp 256
        
        Extraoral: Symptoms begin with Malaise, sore throat, and upper respiratory congestion. Fever and slight lymphadenopathy usually precede or occur concurrently with a vesicular rash that appears on the trunk, head, and neck. Vesicles form pustules and then ulcers with an erythematous border. Lesions are extremely pruritic. and difficult to keep the patient from scratching. Burkhart, Delong. pp 255
        
        Significant Microscopic Feats: Superficial intra epithelial vesicles, free-floating Tzanck cells, and cells that may be multinucleated.
        Burkhart, Delong. pp 256
      - Dental implications: Treatment should not proceed until the person is completely healed without any visible exudates in any of the lesions. Burkhart, Delong. pp 256
      - Treatment and Prognosis: Palliative care is suggested, with topical preparations to relieve pruritus. Nonaspirin anitpyretics are recommended for any discomfort. Aspirin is contraindicated due to the risk for Reye Syndrome. Complete resolution should occur in 2-3 weeks. Vaccines are also provided for children and are usually given in combination with the MMR. Burkhart, Delong. pp 256
      - Method of transmission: Through air droplets or direct contact with lesions. It is highly contagious when lesions are present and weeping.
        Burkhart, Delong. pp 254
      - Etiology: The HHV-3 virus is the causative agent of primary varicella infection.
        Burkhart, Delong. pp 254
    - - Characteristics
        
        Intraoral/perioral: Introral presentation is unilateral and consists of small vesicular eruptions on mucosal surfaces and the hard palate.
        Burkhart, Delong. pp 257
        
        Distinguishing: May be diagnosed clinically when the unilateral distribution of skin lesions is evident. Virus does not migrate far from beyond the skin and mucous membranes.
        Burkhart, Delong. pp 257
        
        Extraoral: Presents unilaterally over the sensory nerve affected in the head, neck, and trunk. Vesicles rupture and become shallow ulcerations that crust over. there may also be fever, pain, malaise, and lymphadenopathy.
        Burkhart, Delong. pp 257
        
        Significant Microscopic Feats: The same as the primary infection
        Burkhart, Delong. pp 257
      - Dental implications: Postherpetic neuralgia may be experienced and can last up to 90 days after the rash onset. Ramsay Hunt Syndrome, blindness, Spontaneous tooth exfoliation, pulpal necrosis, and osteonecrosis of the mandible is possible. Burkhart, Delong. pp 257-258
      - Method of transmission: No method of transmission. Contact with lesions can cause primary disease.
        Burkhart, Delong. pp 256
      - Treatment and Prognosis: Isolation, local managment of the skin lesions, controlling pain, antiviral medication, and treatment of herpetic neuralgia. Palliative procedures are recommended with antiviral agents to reduce viral shedding. Gabapentin and lidocaine pathes used to treat PHN. Oral lesions should be treated with a mouth rinse or topical anesthetic. The vaccine is the main way to prevent chickenpox and shingles.
        Burkhart, Delong. pp 258
      - Etiology: Caused by reactivation of the latent varicella virus. Burkhart, Delong. pp 256
  - - - Characteristics
        
        Intraoral/perioral: Intraoral lesions usually precede the cutaneous rash and may appear on any mucosal surface. The lesions for vesicles that rupture ulcerate, and become very painful. Usually found on the tongue, palate, or buccal mucosa.
        Burkhart, Delong. pp 259
        
        Distinguishing: Vesicles and ulcers occur on the buccal mucosa , tongue, and hard palate only. External lesions appear of the soles of the feet, palms of the hands, and fingers and toes.
        Burkhart, Delong. pp 259
        
        Extraoral: A maculopapular rash occurs on the soles of the feet and palms of the hands. these lesions develop central vesicles that might rupture and crust before healing. Systemic involvement includes fever, sore throat, malaise, and lymphadenopathy.
        Burkhart, Delong. pp 259
        
        Significant Microscopic Feats: Intraepithelial vesicles precede shallow ulcerations.
        Burkhart, Delong. pp 259
      - Dental Implications: The oral lesions cause pain and difficulty with eating and swallowing
        Burkhart, Delong. pp 259
      - Method of Transmission: The virus is transmitted through air bourne and oral/fecal routes, fomites, and respiratory droplets. Burkhart, Delong. pp 258
      - Treatment and Prognosis: Directed toward symptomatic relief, Antipyretic agents and topical medications for sore mouth are the treatments of choice. prognosis is excellent and no complications are expected.
        Burkhart, Delong. pp 259
      - Etiology: The coxsackie A-16 and other coxsackie A and B strains cause hand-foot-and- mouth disease.
        Burkhart, Delong. pp 258
    - - Characteristics
        
        Intraoral/perioral: Characterized by vesicular lesions ranging in size from 1-2 mm.
        Burkhart, Delong. pp 260
        
        Distinguishing: the vesicles are small vesicle and ulcerations in the pharyngeal area.
        Burkhart, Delong. pp 260
        
        Extraoral: Oral lesions are found in the posterior regions of the mouth, soft palate, anterior and posterior pharyngeal pillars, and tonsils. Herpangina presents with a diffuse reddening of the tissues and the appearance of vesicles that rupture and ulcerate.
        Burkhart, Delong. pp 260
        
        Significant Microscopic Feats: N/A
        Burkhart, Delong. pp 260
      - Dental Implications: Needs to be postponed until all vesicles and ulcerations are healed. Burkhart, Delong. pp 260
      - Method of Transmission: Easily transmitted through oral/fecal route. Summer is the optimal time for transmission.
        Burkhart, Delong. pp 260
      - Treatment and Prognosis: palliative treatment is recommended and may or may not be required. Prognosis is excellent and complications are rare.
        Burkhart, Delong. pp 260
      - Etiology: Caused by the A-16 coxsackievirus. Often found in schools or daycare centers due to the prevalence in young people.
        Burkhart, Delong. pp 260
  - - - Characteristics
        
        Intraaoral/perioral: Characteristic lesions called Koplik spots are found intraorally on the buccal and labial mucosa during the initial stage of measles. These precede the extraoral rash.They appear as small bluish white spots on an erythematous background.
        Burkhart, Delong. pp 260
        
        Distinguishing: Koplik spots and the cutaneous rash are usually diagnostic.
        Burkhart, Delong. pp 260
        
        Extraoral: The dermal erythematous rash begins on the face and moves downward to cover the trunk and extremities.
        Burkhart, Delong. pp 260
        
        Significant Microscopic Feats: Epithelial cells become necrotic.
        Burkhart, Delong. pp 260
      - Dental implications: All dental work should be postponed until the virus has been eliminated.
        Burkhart, Delong. pp 261
      - Method of Transmission: Measles is airbone and spreads through respiratory droplets.
        Burkhart, Delong. pp 260
      - Treatment and Prognosis: treatment is palliative with nonaspirin antipyretics. Complications ma include pneumonia, and encephalitis.
        Burkhart, Delong. pp 261
      - Etiology: Originates from the Paramyxoviridae family. If exposure occurs, those not vaccinated are susceptible. Burkhart, Delong. pp 260
  - - - Characteristics
        
        Intraoral/Perioral: Small, discrete, dark-red papules on the soft and hard palate occur in some cases. (Forchheimer signs)
        Burkhart, Delong. pp 261
        
        Distinguishing: Forchheimer signs may be evident in the soft palate region and are considered early signs.
        Burkhart, Delong. pp 261
        
        Extraoral: Patients usually complain of malaise, fever, nausea, and poor appetite. Lymphadenopathy is evident, with red and pink papules on the body.
        Burkhart, Delong. pp 261
        
        Significant Microscopic Feats: Serologic analysis is required to confirm.
        Burkhart, Delong. pp 261
      - Dental implications: N/A Burkhart, Delong. pp 261
      - Method of Transmission: Highly contagious and spreads through respiratory droplets.
        Burkhart, Delong. pp 261
      - Treatment and prognosis: Nonaspirin antipyretic medications may be helpful in soothing the discomfort. Should send patient to their physician if lesions are present anywhere. Burkhart, Delong. pp 261
      - Etiology: Togavirus causes rubella (german measles). It replicates in the oropharynx and regional lymph nodes and spreads through the bloodstream to the skin and distal organs.
        Burkhart, Delong. pp 261
- - - - Intraoral/perioral: Those with the dystrophic and junctional forms usually require dental care. Their oral erosions may be mild or severe with scarring. Bullae and painful erythematous or ulcerative lesions can be found on any oral mucosal surface.In the severe types, eating or oral hygiene can cause traumatic insult, resulting in lesion formation.
        Burkhart, Delong. pp 267
      - Distinguishing: All lesions occur due to trauma and can heal with some scarring. Fingernails are often obliterated due to scarring over time. Scarring can result in ankyloglossia, microstomia, and vestibular obliteration. This can make eating very difficult.
        Burkhart, Delong. pp 267
      - Extraoral: All feature bulla formation at birth. vary between types. The deeper the cleavage the greater the likelihood of severe scarring as is often seen in the dystrophic forms. Skin lesions often affect areas of exposure and abrasion such as hands, knees, axilla, and the groin, but all the skin has an increased fragility. Crusted erosions, milia, pigmentation, and alopecia are commonly seen. Digital webbing with mitten-type deformities of the hands and feet may be seen. Anemia is associated with certain subtypes.
        Burkhart, Delong. pp 267
      - Significant Microscopic Feats: Histopathic features depend on the genetic abnormality present. All forms involve separation of the epithelium from the underlying connective tissue. Blistering occurs in epidermis, orwithin the basement membrane in inherited forms. In the mixed type, this separation is variable.
        Burkhart, Delong. pp 267
- - - - Extraoral: none
        Burkhart, Delong. pp 248
      - Intraoral/perioral: May have a blue hue with a transparent appearance. most appear slightly elevated and have a smooth, dome shaped appearance. Can be found in the oral mucosa, palate, and anywhere with salivary gland function or accessory gland ducts. Most occur on the lower lip lateral to the midline, floor of the mouth, ventral tongue, and buccal mucosa. Burkhart, Delong. pp 248
      - Distinguishing: The cloudy blue hue. Size may fluctuate from millimeter to centimeters and my rupture. Some uncommon variants called superficial mucoceles may also appear on the soft palate and retromolar pads. They look like vesicles and may be confused with mucous membrane pemphigold. These occur in conjunction with lichen planus , lichenoid drug reactions, and chronic graft versus host disease Burkhart, Delong. pp 248-249
      - Significant Microscopic Features: A mucin pool walled off by granulation tissue. The severed duct shows ductal dilation, and an inflammatory response is initiated
        Burkhart, Delong. pp 249