Decision tree analysis for the management of vesiculobullous lesions

Swathi K. V.; Maragathavalli G.

doi:10.51248/.v43i4.3017

Authors

Swathi K. V.
Maragathavalli G.

DOI:

https://doi.org/10.51248/.v43i4.3017

Keywords:

vesiculobullous, mucocutaneous, infectious, immunobullous, genetic

Abstract

A mucocutaneous condition known as a vesiculobullous lesion is characterized by the presence of fluid-filled vesicles and bullae. Bullae and vesicles typically have different sizes. Bullae have a diameter greater than 5–10 mm, whereas vesicles have a diameter of less than 5–10 mm. Infectious etiologies such herpes simplex, varicella zoster infection, hand, foot, and mouth disease, herpangina, and measles can cause vesiculobullous lesions. Additionally, immunobullous conditions including pemphigus vulgaris, pemphigoid, dermatitis herpetiformis, linear IgA disease, or inherited conditions like epidermolysis bullosa may be to blame. The management of common vesiculobullous disorders is reviewed using a decision tree analysis based on etiopathogenesis, clinical characteristics, and diagnostic criteria. A decision tree has been formulated based on predominantly vesicular and predominantly bullous lesions with specific lesions in each category based on recent scientific evidence. This decision tree will guide the clinicians for effective management of the vesiculobullous lesions in the dental office. The timely recognition and management of these lesions is very essential as they can compromise the quality of life due to their chronicity and frequent recurrence in nature.

Author Biographies

Swathi K. V.

Department of Oral Medicine and Radiology, SRM Dental College, Ramapuram, Chennai, 600089, Tamil Nadu, India

Maragathavalli G.

Department of Oral Medicine and Radiology, Saveetha Dental College, Chennai, 600077, Tamil Nadu, India

References

Rastogi, V., Sharma, R., Misra, S. R., Yadav, L. Diagnostic procedures for autoimmune vesiculobullous diseases: A review. Journal of oral and maxillofacial pathology: JOMFP, 2014; 18(3): 390-397.

Reddy, S. E., Singaraju, D.K., Govada, J., Rajajee, K.T.S.S., Sudheer, M.V.S., Kumar, S.A., et al., Vesiculobullous lesions of the oral cavity. IAIM, 2016; 3(11):154-163.

Arduino, P. G., Porter, S. R. Herpes simplex virus Type 1 infection: Overview on relevant clinico-pathological features. Journal of Oral Pathology and Medicine: Official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2008; 37(2): 107-121.

Goldman, R.D. Acyclovir for herpetic gingivostomatitis in children. Can Fam Physician. 2016; 62(5):403-404.

Strick, L.B., Wald. A., Celum, C. Management of herpes simplex virus type 2 infection in HIV type 1-infected persons. Clin Infect Dis. 2006; 43(3):347-356.

Mueller, N.H., Gilden, D.H., Cohrs, R.J., Mahalingam, R., Nagel, M.A. Varicella zoster virus infection: clinical features, molecular pathogenesis of disease, and latency. Neurol Clin. 2008; 26(3):675-697.

Skripuletz, T., Pars, K., Schulte, A., Schwenkenbecher, P., Yildiz, Ö., Ganzenmueller, T., et al., Varicella zoster virus infections in neurological patients: a clinical study. BMC infectious diseases, 2018; 18(1): 238.

Jeon, Y., & Lee, H. Ramsay Hunt syndrome. Journal of Dental Anaesthesia and Pain Medicine, 2018;18(6): 333-337.

Kasperkiewicz, M., Ellebrecht, C. T., Takahashi, H., Yamagami, J., Zillikens, D., Payne, A. S., et al., Pemphigus. Nature reviews. Disease primers. 2017; 3: 17026.

Tamgadge, S., Tamgadge, A., Bhatt, D. M., Bhalerao, S., Pereira, T. Pemphigus vulgaris. Contemporary Clinical Dentistry. 2011; 2(2): 134-137.

Noormohammadpour, P., Ehsani, A., Mortazavi, H., Daneshpazhooh, M., Balighi, K., Mofidi, M., et al., Rituximab therapy improves recalcitrant Pemphigus vulgaris. EXCLI Journal, 2015; 14: 109-116.

Haripriya, A., Ilangani, I., Anbu Meena, S., Ahmed, S.P. Kannan, A. case report -Diagnostic challenges of a rare case of pemphigus in the oral cavity. Annals of R.S.C.B, 2021; 25(4): 5366-5374.

Kridin, K. Emerging treatment options for the management of pemphigus vulgaris. Therapeutics and Clinical Risk Management. 2018; 14: 757-778.

Hammers, C. M., Stanley, J. R. Mechanisms of Disease: Pemphigus and Bullous Pemphigoid. Annual Review of Pathology. 2016; 11: 175-197.

Gregoriou, S., Efthymiou, O., Stefanaki, C., Rigopoulos, D. Management of Pemphigus vulgaris: challenges and solutions. Clinical, Cosmetic and Investigational Dermatology. 2015; 8: 521-527.

Khandpur, S., Verma, P. Bullous pemphigoid. Indian Journal of Dermatology, Venereology and Leprology. 2011; 77(4): 450-455.

Dharman, S., Muthukrishnan, A. Oral mucous membrane pemphigoid - Two case reports with varied clinical presentation. Journal of Indian Society of Periodontology, 2016; 20(6): 630-634.

Georgoudis, P., Sabatino, F., Szentmary, N., Palioura, S., Fodor, E., Hamada, S., et al., Ocular mucous membrane pemphigoid: Current State of Pathophysiology, Diagnostics and Treatment. Ophthalmology and therapy, 2019; 8(1): 5-17.

Xu, H. H., Werth, V. P., Parisi, E., Sollecito, T. P. Mucous membrane pemphigoid. Dental Clinics of North America. 2013; 57(4): 611-630.

Hasan, S., Jangra, J., Choudhary, P., Mishra, S. Erythema multiforme: A recent update. Biomed Pharmacol J. 2018; 11(1): 167-170.

Rawson, K., Rani, R. U., Susan, S., Roy, G., Gupta, N. Drug induced erythema multiforme: Reporting 2 cases. J Indian Acad Oral Med Radiol. 2018; 30:306-309.

Shrihari, T. G., Shetty, S.R. Erythema multiforme: A mysterious lesion. Indian J Med Paediatr Oncol. 2018;39:363-367.

Kaliyadan, F. Dermoscopy of erythema multiforme. Indian Dermatol Online J. 2017; 8(1):75.