CHRONIC VESICO – BULLOUS

CLASSIFICATION OF CVB
1. EPIDERMAL BLISTER
- Pemphigus vulgaris
- Pemphigus foliaceus
- Pemphigus erythematous
2. SUB-EPIDERMAL BLISTER
- Bullous pemphygoid
- Dermatitis herpetiformis
3. INFRA-BASAL BLISTER
- Dermatitis herpetiformis
 CVB
Oral mucosa membran:
- Bucal mucosa
- Palatum
- Ventral and dorsal tongue
PEMPHIGUS VULGARIS

Definition :
A disease of skin and mucous
membrane that characterized by
chronic intraepidermal blister on
normal to erythematous skin
 EPIDEMIOLOGY
• Male = female, age : 50-60 years
• Children are rare

ETIOLOGY
• Certainty?
• Drugs : penicillamine, sulfhidryl,
captopril,penicillin,rifampicin,etc.
CLINICAL FEATURES

 flaccid vesicles or blister, fragile, erosion

hyperpigmentation and crusts
 oral mucous membrane(bucal,palatum
esofagus with swallowing disorder
 Predilection : oral mucous membrane,
scalp, trunk, buttock, face, neck, armpit,
genital
 PATHOGENESIS

auto-immune mechanism, acantholysis, intra epidermal

antibody binding surface cell glycoprotein

plasmin and enzyme activity

Intercellular cement damage

 SUPPORTING EXAMINATION
 Nikolsky’s sign
 Asboe-Hansen’s sign (“spread phenomen”)
 Histopathology :
- acantholytic cells (Tzanck’s method)
- intra epidermal blister
- IgG dermoepidermal junction
(immunofluorescence)
 TREATMENT
 Severe, hospitalized
 Topical and systemic therapy,

corticosteroid, immunosupressive agent,

cyclophosphamide
PROGNOSIS
• Quo ad vitam, high mortality rate
• Quo ad functionam, dubia
• Quo ad sanationam, dubia
 Pemphigus vulgaris

Flaccid bullae

At mucous membrane
Flaccid bullae easily ruptur
Pemphigus foliaceus
Pemphigus erythematous
 PEMPHYGOID BULLOSA
DEFINITION :
tense vesicles/blister,chronic,erythematous base
ETIOLOGY :
 Certainty ?

 Auto-immune (concomittant with other

autoimmune diseases,e.g. rheumatoid,

myastenia gravis)
EPIDEMIOLOGY :
 All ages, especially elderly

 Male = female
 PATHOGENESIS

Antigen Complex + Antibodies (IgG,C3,IgM)

Lamina lucida (BMZ)

Inflammation, tissues damage

CLINICAL FEATURES
 Good general state, mucous
membrane(buccal,palatum)
 Predilection : armpit, flexor forearm, groin
 Vesicles,blister,erosion
Supporting Examination
 Histopathology, sub epidermal blister
 IgG,C3 sedimentation  dermoepidermal junction
Treatment
 Topical
 Systemic :
Corticosteroid
Dapsone
Sulphapyrimidine
Bullous Pemphigoid

Tense bullae
 DERMATITIS HERPETIFORMIS
(Duhring’s disease)

 DEFINITION
Clustered vesico-bullous, erythematous base,
severe itching
 EPIDEMIOLOGY

- Male = female
- Age of 20-40 years
- Children : rare
• ETIOLOGY ?
• CLINICAL FEATURES
Vesicle-blister,tense, content clear fluid
turbid, subjective severe itching

predilection: scalp, posterior neck, posterior armpit,

sacral,extensor forearm,knee,and elbow

• PATHOGENESIS
Disorder of jejunum mucosa
Gluten + IgA inflammatory response
skin damage
SUPPORTING EXAMINATION
- KI test
-Histopathology:

subepidermal blister, eosinophilic infiltration

-Immunofluorescence, IgA & C3 deposits in dermal papillary

TREATMENT :
- Gluten-free diet
-Topical

-Systemic: DDS, sulfapyridine, sulfazaladine

PROGNOSIS :
- Quo ad vitam and functionam ad bonam
-Quo ad sanationam dubia (recidive chronic)
Dermatitis herpetiformis