Jayasri, J (2012) A Clinico-Epidemiological study of Oral Lesions in Acquired Bullous Dermatoses. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION Oral cavity occupies a unique position in the human body. As it is situated anatomically between the skin externally and the intestinal mucosa internally, it shows some properties of each in various aspects. Hence it can act as a marker of both cutaneous as well as internal diseases. A number of diseases affect both skin and the oral mucosa and in some, the oral involvement precedes the skin disease and can well help the disease to be identified earlier thereby making the management feasible at an earlier course of the disease, thus reducing the morbidity of the disease considerably. The oral mucosa differs from the skin anatomically in several aspects. With the exception of the dorsum of the tongue and the hard palate, stratum corneum and stratum granulosum are not present in the mucous membrane of the mouth. Where these layers are absent, the epithelial cells appear vacuolated as a result of their glycogen content. The epithelial cells of the oral mucosa show only few well-developed desmosomes and instead, they show numerous microvilli at their borders. A careful scrutiny of the oral mucosa becomes an essential and integral part of dermatological examination, especially when it comes to vesiculobullous dermatoses. Autoimmune vesiculobullous disorders, in particular, more frequently affect the oral cavity in a severe manner affecting the oral intake and general nourishment of the body which in turn increases the morbidity. The interpretation of signs and symptoms in oral cavity poses difficulty due to its anatomical and functional properties. The vesicular lesions easily rupture leaving erosions. Painful nature of most of the vesiculobullous lesions leads to difficulty in maintaining proper oral hygiene. The ulcers get easily infected and consequently become foul smelling. Thus it is important to know the various oral manifestations of vesiculobullous disorders in order to facilitate an early diagnosis and treatment which will pave way for significant reduction in the morbidity. AIM OF THE STUDY : 1. To study the various acquired bullous dermatoses causing oral lesions. 2. To study the age distribution. 3. To study the sex distribution. 4. To study the intra oral distribution of lesions. 5. To study the evolution of the oral lesions with regard to the skin lesions in autoimmune bullous diseases. MATERIALS AND METHODS : Study design : Single centred hospital based cross sectional study. Study period : October 2009 to September 2011. Sample size : Two hundred and fifty two patients. Data collection : Proforma based. Inclusion criteria : Patients of acquired vesiculobullous disorders of all ages and both sex with active disease. Exclusion criteria: 1. Patients who have undergone treatment and those with inactive disease as evidenced by absence of lesions during the study period. 2. Patients who are unwilling to get included in the study. All patients with acquired vesiculobullous disorders who attended the out patient division of Dermatology department, Rajiv Gandhi Government General Hospital, Chennai from October 2009 to September 2011 were screened for oral lesions and detailed history was taken. Patients were enquired regarding the onset, duration of the disease, the evolution of the lesions, whether the oral lesions preceded or followed or appeared at the same time with the skin lesions and any drug intake prior to the onset of the lesions. Precipitating or aggravating factors were noted. History of constitutional symptoms, loss of weight and appetite, melena, urticarial weals, pruritus, photosentivity, abdominal pain, diarrhoea, constipation, joint pain, symptoms of the oral lesions, previous similar episodes were noted. Other coexisting diseases if present, were documented. Personal history regarding diet, other associated diseases and treatment history were noted. Family history of similar skin disease was taken. All patients were subjected to routine clinical examination including general, systemic and dermatological examinations. The morphology and distribution of the lesions in the skin and oral cavity were recorded. Clinical signs (Nikolsky’s sign, bulla spreading sign) were elicited in the respective patients. The extent of oral lesion in patients with pemphigus vulgaris was rated using 3 grades as follows: Grade I - Only 1 site is involved; Grade II - 2 sites are involved; Grade III - 3 or more sites are involved. RESULTS : Out of the total 87,429 patients who attended the dermatology OPD during the study period, 252 patients were acquired vesiculobullous dermatoses (0.29%). Among these, 126 were viral infections, 114 were autoimmune bullous dermatoses and 12 were drug induced. Of the total 252 patients, oral lesions were present in 175 patients (69.4%). Among the 126 patients with viral infections, 92 had oral lesions (73%). Among the autoimmune group, 72 out of 114 patients had oral lesions (63.2%). Of the 12 patients in the drug induced group, 11 had oral lesions (91.7%). CONCLUSION : 1. Acquired vesiculobullous dermatoses constituted 0.29% of the total patients attending Dermatology OP division and 69.4% of them had oral involvement. 2. Viral infections are the most common subdivision of vesiculobullous dermatoses. Majority of the viral infections were seen before the 4th decade of life. No sex predilection was seen as a whole or in any of the individual viral infections. Lips were the most common sites to get involved in viral infections. 3. Herpes simplex was the most common viral infection found mainly in <40 years of age while herpes zoster was seen above 40 years of age. 4. Autoimmune bullous disorders constituted 45.2% of the total patients and 63.2% of these patients had oral lesions. The age distribution varied from 17–85 years. The male to female was 1: 2.4. 5. Pemphigus vulgaris was the most common autoimmune bullous dermatoses followed by bullous pemphigoid. Pemphigus vulgaris was most commonly seen in 4th decade followed by 5th decade while bullous pemphigoid was more common in the seventh followed by sixth decade. Oral mucosal involvement was seen in 89.7% of pemphigus vulgaris and 27% of bullous pemphigoid patients. 6. The male to female ratio was 1 : 3.9 in pemphigus vulgaris and 1 : 1.4 in bullous pemphigoid. 7. Buccal mucosa was the most common site to get involved in both pemphigus vulgaris and bullous pemphigoid. Isolated oral mucosal involvement was found in 11.8% of patients with pemphigus vulgaris. The oral lesions preceded the onset of skin lesions in 62.3% of patients and the average time interval between the onset of each was 36.6 days. 8. Early diagnosis can be made by biopsy of the oral lesions in autoimmune vesiculobullous dermatoses in those patients with first involvement in the oral mucosa. 9. Drug induced vesiculobullous dermatoses constituted 4.8% of the total patients. Antimicrobials and analgesics were the most common offending agents. Majority of the patients were below forty years of age. The male to female ratio was 1.4:1. 10. The oral cavity was involved in 91.7% of the patients. Lips were the most frequently involved sites seen in 100% of the patients with oral lesions. 11. Early diagnosis and prompt treatment will help reducing the morbidity and mortality in drug induced dermatoses.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Oral Lesions ; Acquired Bullous Dermatoses ; Clinico-Epidemiological study. |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Subramani R |
| Date Deposited: | 01 Mar 2018 16:55 |
| Last Modified: | 01 Mar 2018 16:55 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5946 |
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