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Презентация на тему Bullous and vesicular dermatoses

Theoretical partThe group of vesicular and bullosus dermatoses includes different diseases on the basis of etiology and pathogenesis (pemphigus, Duhring’s dermatosis, simple vesicular lichens, herpes zoster, exudative multimorphic erythema).
Bullous and Vesicular Dermatoses  Zaporozhye 2016 Theoretical partThe group of vesicular and bullosus dermatoses includes different diseases on True (acantholytic) pemphigusPemphigus is a malignant, serious disease. Its clinical manifestation is Etiology and pathogenesis of pemphigusThere are different etiopathogenic theories, in particular, the Clinical varieties Four forms of true pemphigus are differentiated: pemphigus vulgaris (common) Pemphigus Vulgaris This form of pemphigus accounts for approximately 75 per cent Pemphigus VulgarisUsually dermatosis begins with affection of the oral and throat mucosa, Pemphigus Vegetans At the beginning of its development this form of pemphigus Pemphigus VegetansPapulomatous growths secreting a considerable amount of exudate are formed later Pemphigus Foliaceus The disease is characterized by drastic acantholysis leading to the Pemphigus seborrhoicus, or erythematosus (Senear-Usher syndrome)Pemphigus seborrhoicus belongs to the group of Pemphigus seborrhoicus, or erythematosusThe lesions usually first appear on the face and Diagnosis and differential diagnosisDifferential diagnosis is carried out with multiform exudative erythema, Dermatitis herpetiformis (Duhring’s disease) Herpes simplex The disease is caused by a filtrable virus and is TreatmentTreatment with steroid hormones envisages the prescription of maximum doses (80-100 mg Treatment. Drying and disinfectant agents are used externally: lotions of Aq. Goulardi The following clinical forms are distinguished: mild; with rapid resolution of the Histopathology The characteristic findings are ballooning and, to a lesser extent, reticular Herpes zoster Herpes zoster, also called shingles or zona, is caused by The following clinical varieties are distin­guished: generalized herpes zoster marked by bilateral Histopathology. Ballooning and reticular degeneration of the epi­dermal cells, intranuclear viral inclusions, Treatment. Antiviral drugs such as methisazonum or cutizonum (one taken two or
Слайды презентации

Слайд 2 Theoretical part
The group of vesicular and bullosus dermatoses

Theoretical partThe group of vesicular and bullosus dermatoses includes different diseases

includes different diseases on the basis of etiology and

pathogenesis (pemphigus, Duhring’s dermatosis, simple vesicular lichens, herpes zoster, exudative multimorphic erythema).

Слайд 3 True (acantholytic) pemphigus
Pemphigus is a malignant, serious disease.

True (acantholytic) pemphigusPemphigus is a malignant, serious disease. Its clinical manifestation

Its clinical manifestation is the formation of vesicles on

non-inflamed skin and mucous membranes. If not treated the bulloses soon appear on the whole skin. Patients should consult not only dermatologists but also other specialists (physicians, dentists, infectionists). Due to this, the knowledge of this pathology is necessary for all the clinicians to render qualified help to the patients.

Слайд 4 Etiology and pathogenesis of pemphigus
There are different etiopathogenic

Etiology and pathogenesis of pemphigusThere are different etiopathogenic theories, in particular,

theories, in particular, the viral theory but it is

not completely proved. Recently autoimmune processes are considered to be of great importance in the pathogenesis: discovery of antibodies to intercellular substance in the skin, in liquid of the bulloses and in blood serum. In immunofluorescence, in intercellular space of stratum spinosum of epidermis immunoglobulin G is found only in the patients with pemphigus.

Слайд 5 Clinical varieties
Four forms of true pemphigus are

Clinical varieties Four forms of true pemphigus are differentiated: pemphigus vulgaris

differentiated:
pemphigus vulgaris (common) pemphigus vegetans
pemphigus foliaceus (exfoliative)

seborrheal pemphigus

Слайд 6 Pemphigus Vulgaris
This form of pemphigus accounts for approximately

Pemphigus Vulgaris This form of pemphigus accounts for approximately 75 per

75 per cent of the total number of all

forms of pemphigus


Слайд 7 Pemphigus Vulgaris
Usually dermatosis begins with affection of the

Pemphigus VulgarisUsually dermatosis begins with affection of the oral and throat

oral and throat mucosa, after which, as a rule,

the skin of the trunk, limbs, inguinal region, axillae, face and external genitals is involved in the process.

Слайд 8 Pemphigus Vegetans
At the beginning of its development this

Pemphigus Vegetans At the beginning of its development this form of

form of pemphigus is clinically similar to pemphigus vulgaris

and often starts with the appearance of lesions on the oral mucosa. From the very onset of the disease, however, attention is drawn to the tendency of the bullae to be localized around the natural orifices, the navel and in the region of the large skin folds

Слайд 9 Pemphigus Vegetans
Papulomatous growths secreting a considerable amount of

Pemphigus VegetansPapulomatous growths secreting a considerable amount of exudate are formed

exudate are formed later in places of the ruptured

bullae against the background of an eroded surface covered with a dirty film. The lesions tend to coalesce and form large vegetative surfaces at places with purulent necrotic disintegration. Nikolsky's sign is often positive. The dermatosis is accompanied with pain and a sensation of burning. Active movements are difficult because of sharp pain

Слайд 10 Pemphigus Foliaceus
The disease is characterized by drastic acantholysis

Pemphigus Foliaceus The disease is characterized by drastic acantholysis leading to

leading to the formation of superficial fissures directly under

the horny layer, which later turn into bullae.
At the beginning of the disease, flaccid bullae with a thin top and slightly elevated above the surface form on apparently healthy skin. They rupture rapidly with the formation of large erosions. More frequently the tops of the bullae dry up into thin stratified scaly crusts. Epithelization of erosions under the crusts is slow. New portions of the exudate cause the layering of these crusts, producing a scaly surface, hence there is a term 'exfoliative', by which the disease is also known. It is in this variant of pemphigus that the sign described by Nikolsky in 1896 is always sharply positive.

Слайд 11 Pemphigus seborrhoicus, or erythematosus (Senear-Usher syndrome)
Pemphigus seborrhoicus belongs to

Pemphigus seborrhoicus, or erythematosus (Senear-Usher syndrome)Pemphigus seborrhoicus belongs to the group

the group of true pemphigus because the possibility of

its development into the foliaceus or vulgaris variant has been authentically proved.

Слайд 12 Pemphigus seborrhoicus, or erythematosus
The lesions usually first appear on

Pemphigus seborrhoicus, or erythematosusThe lesions usually first appear on the face

the face and less frequently on the scalp, chest

and back. Closely arranged greasy crusts are formed against an erythematous background and simulate the picture of cicatrizing erythematosis on the face. Moist eroded surfaces are exposed when the crusts are removed. Acantholytic cells are seen in impression smears from these surfaces. The bullae are often formed unnoticeably and the crusts seem to be primary lesions. In other cases vesicles covered with stratified yellowish crusts are formed on the trunk and limbs, in sites characteristic of seborrhea. Lesions rarely occur on the mucous membranes, but if this happens, they are a bad prognostic sign.

Слайд 13 Diagnosis and differential diagnosis
Differential diagnosis is carried out

Diagnosis and differential diagnosisDifferential diagnosis is carried out with multiform exudative

with multiform exudative erythema, bullous toxicoderma (Lyell’s syndrome) and

Duhring’s dermatosis

Слайд 14 Dermatitis herpetiformis (Duhring’s disease)

Dermatitis herpetiformis (Duhring’s disease)

Слайд 15 Herpes simplex
The disease is caused by a filtrable

Herpes simplex The disease is caused by a filtrable virus and

virus and is characterized by eruption of grouped vesicles

filled with a clear and then thick content, on a hyperemic area. The primary sites are the lips (herpes labialis), cheeks (herpes facialis), the wings of the nose (herpes nasalis), oral mucosa (herpes buccalis), cornea (herpes corneae), and genitals (herpes genitalis).

Слайд 16 Treatment
Treatment with steroid hormones envisages the prescription of

TreatmentTreatment with steroid hormones envisages the prescription of maximum doses (80-100

maximum doses (80-100 mg of prednisolone or methylprednisolone, 4‑6 mg

of dexamethasone daily). When new eruptions cease to appear and exudative phenomena in the foci diminishes, the dose of corticosteroids may be reduced, but very slowly (to avoid exacerbation of the process and prevent the 'phenomenon of steroid drug discontinuation').


Слайд 17 Treatment.
Drying and disinfectant agents are used externally:

Treatment. Drying and disinfectant agents are used externally: lotions of Aq.

lotions of Aq. Goulardi and 1-4 per cent silver

nitrate solution, 1-2 per cent pyoktanin (gentian violet) solution, 1-2-3 per cent oxolinum or 30-50 per cent interferon ointment, Bonaphton, gossypol, tebrophenum, 1-3 per cent Florenal ointment, and sulfur-carbolic paste (Ac. carbolici 1.0, Sulfuris 1.5, Pastae Zinci 30.0).

Слайд 18 The following clinical forms are distinguished:
mild; with

The following clinical forms are distinguished: mild; with rapid resolution of

rapid resolution of the few lesions that have erupted;


edematous; accompa­nied with bright hyperemia and marked swelling;
severe;
zosteriform;
frequently recurring; loca­lized on the lips, buttocks, and external genitals.

Слайд 19 Histopathology
The characteristic findings are ballooning and, to

Histopathology The characteristic findings are ballooning and, to a lesser extent,

a lesser extent, reticular degeneration of the epidermal cells

and acantholysis. There are intranuclear eosinophilic inclusions in the ballooning cells and dilated blood vessels, edema, and mild perivascular infiltration in the dermal papillary layer.

Слайд 20 Herpes zoster
Herpes zoster, also called shingles or zona,

Herpes zoster Herpes zoster, also called shingles or zona, is caused

is caused by a neurotropic filtrable virus Strongiloplasma zonae

which resembles or is identical with the chickenpox virus in antigenic structure and the ability to grow in human embryonic tissues

Слайд 21 The following clinical varieties are distin­guished:
generalized herpes

The following clinical varieties are distin­guished: generalized herpes zoster marked by

zoster marked by bilateral and disseminated lesions;
herpes zoster

haemorrhagicus, in which the clear contents of the vesicles turn purulent and then, when the process penetrates deeper into the dermis, become hemorrhagic;
herpes zoster gangraenosus, a severe form, in which the floor of the vesicles undergoes necrosis and scars are formed in their place;
mild form;
bullous form characterized by the appearance of both vesicles and bullae.

Слайд 22 Histopathology.
Ballooning and reticular degeneration of the epi­dermal

Histopathology. Ballooning and reticular degeneration of the epi­dermal cells, intranuclear viral

cells, intranuclear viral inclusions, and degenerative changes in the

nerve fibres may be seen. Acute inflammatory polymorphonuclear infiltration predominantly of a lymphocyto-histio-cytic character, edema, and dilated blood and lymph vessels are revealed.

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