VESICULOBULLOUS

LESIONS
Viral etiology
Primary Herpetic Gingivostomatitis
 Primary Herpetic
Gingivostomatitis
Aetiology- HSV type 1, ( 2)
Incidence- children under 10 years old
Clinical features- incubation period 3-7 days
-multiple vesicles, scattered
ulcers,yellow slough, erythematous halo
-cervical lymphadenitis, fever, malaise, irritability,
anorexia
Diagnosis- viral culture,electron microscopy, titre of
antibody
Treatment-soft diet, fluid intake, antipyretics/analgesis,
local antiseptics-0,2% chlorhexidine
Aciclovir orally/ parenterally
Secondary Herpetic Stomatitis
Recurrent Herpes Simplex
Recurrent Herpes Simplex( Herpes labialis)

Aetiology- HSV type 1, ( 2)

HSV latent in trigeminal ganglion is reactivated
by:
-sun, trauma, fever, menstruation,
immunosuppression
Clinical features-prodromal
paraesthesia or irritation
-erythema vesicles>ulcers>scabs
Treatment-aciclovir 5% cream/
Penciclovir 1%, each 2h/ apllied in
prodrome
-systemic aciclovir
Varicella (Chickenpox)
Varicella (Chickenpox
- Aetiology- VZV- herpes varicella zoster virus
Incidence-common childhood exanthem
Clinical features- incubation period 14-21 days
-ulcers-indistinguishable from HSV,
but no associated gingivitis
-rash- face and trunk: papules>vesicles>pustules>Scabs
-cervical lymphadenitis, fever, malaise, irritability,
anorexia
Diagnosis- viral culture,electron microscopy, titre of
antibody
Treatment-symptomatic
soft diet, fluid intake,analgesis, local antiseptics-0,2%
chlorhexidine
Aciclovir / famciclovir/valaciclovir/ parenterally
Herpes Zoster (Shingles)
 Herpes Zoster (Shingles)
Aetiology- Reactivation of VZV latent in sensory ganglia
Incidence- uncommon, affects erderly or
immunocompromised
Clinical features Pain- before, with & after rash
-Rash- unilateral vesiculating> scabbing in dermatome
30%-trigeminal region
-Mouth ulcers- mandibular zoster: ipsilateral on buccal and lingual
mucosa
- maxillary: ipsilateral on palate & vestibule

Diagnosis- clinical
Treatment- Analgetics,
Aciclovir 800mg/ 4 time/day,10 days
famciclovir/valaciclovir/ high dose parenterally
-symptomatic treatment for ulcers
Herpangina
 Herpangina
Aetiology- Coxsackie viruses(A 7,9,16;
B1,2,3,4,5)
Incidence- uncommun, young children
Clinical features- incubation period 2-9 days
- subclinical
Clinical:-pharingeal ulcers, no gingivitis,moderate
cervical lymphadenitis, fever, malaise, irritability,
anorexia,vomiting
Diagnosis- clinical.
Treatment - symptomatic