Vesiculobullous disease

Question 1

Examples of vesiculobullous disease

Answer 1

• Mucous membrane pemphigoid
• Pemphigus vulgaris
• Erythema multiform

Question 2

Clinical features of MMP

Answer 2

• Oral vesicles and and blisters that pop up into ulcers
• Desquamative gingivitis
• Genital and ocular lesions

Question 3

How would you diagnose MMP ?

Answer 3

• Biopsy - histopathology . Direct immunoflourescence ( from perilesional tissue)
• Blood sample - indirect immunofluorescence

Question 4

Clinical features of Pemphigus

Answer 4

• ORal bullae ( rupture quickly leave erosions and ulcers
• Desquamative gingivitis
• Ocular involvement
• Anogenital blistering

Question 5

How to differentiate from MMP and PV clinically?

Answer 5

Nikolsky’s sign ( rubbing the mucosa induces a bullae)

Question 6

Management of MMP and PV?

Answer 6

• Symptomatic relief with betamethasone and difflam then refer
• If eye involvement , consider liaising with ot GP
• Management in oral medicine ; Biopsy , blood tests and provide long term treatment

Question 7

What can cause erythema multiform?

Answer 7

Often acute onset due to
* hypersensitivity reaction
* HSV-1
* Drugs ; NSAIDs , phenytoin
* Following immunisations ( Hep B or BCG)

Question 8

How might erythema multiforme present as?

Answer 8

• Ulceration and blistering of oral mucosa and lips
• Skin rash

Question 9

What is the management of Erythema multiforme

Answer 9

• Refer to oral medicine for advice
  ^ if mild then topical steroids if major will require systemic
  ^ Adjuctive oral care
  ^ Antihistamines for skin itch