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Hematinic has an essential role in the human body. Suppose its deficiency can cause oral disorders such as aphthous stomatitis. Recurrent aphthous stomatitis is the most common oral lesion. It has three types of clinical appearance, namely minor, central, and herpetiform. The main components of hematinic are folate, vitamin B12, folic acid. Apart from hematinic, another nutrient that can correlate with recurrent aphthous stomatitis is zinc. This review explains the relationship between hematinic deficiency and zinc associated with recurrent aphthous stomatitis.

Analysis of various classifications of pemphigus shows that there are no fundamental differences between them. The main distinctions consist in use of diverse terms in naming of some forms of pemphigus and in inclusion or exclusion of certain subtypes from the classifications. Authors propose to use the following classification in the dermatological clinical practice, for educational and scientific purposes and for clinical guidelines: 1) pemphigus vulgaris (1.1. Pemphigu s vegetans); 2) pemphigus foliaceus (2.1. Pemphigus endemic (Fogo selvagem), 2.2. Pemphigus erythematosus (Senear Usher)); 3) herpetiform pemphigus; 4) paraneoplastic pemphigus; 5) IgA pemphigus (5.1. Subcorneal pustular dermatosis, 5.2. Intraepidermal neutrophilic dermatosis).

This article presents a case of clinical observation of a 5-year-old child with herpetiformis dermatitis (Duhrings). This rare dermatosis is characterized by a chronic relapsing course, the presence of itching polymorphic rashes, typical histological and immunomorphological signs. The diagnosis was made on the basis of the clinical picture, histological and immunohistochemical studies of skin biopsy, as well as the results of HLA typing by PCR. Clinical observation of this case is of interest to practicing physicians-dermatologists due to the rare occurrence of Duhrings herpetiformis in children, the complexity of differential diagnostic search, which requires further generalization of experience using histological, immunohistochemical and molecular genetic research methods. The disease is clearly differentiated from other rashes with the formation of subepidermal blisters according to histological, immunological and gastrointestinal criteria. The prevalence of dermatosis in various populations of the Europian race ranges from 10 to 39 cases per 100,000 population. Duhrings dermatitis herpetiformis can develop at any age (cases of the childhood form of Dhrings dermatitis herpetiformis have been reported), but most often the disease occurs at the age of 4050 years. Dermatitis herpetiformis persists indefinitely with variable severity. In patients with Duhrings dermatitis, associated gluten-sensitive enteropathy is often noted, which in most cases is asymptomatic.

Recurring oral ulcers are among most common oral disease encountered by oral physicians in day to day practice. Recurrent apthous stomatitis (RAS) is a common disorder characterized by recurring ulcers confined to the oral mucosa with no other signs of systemic diseases. It affects approximately 20% of general population. Clinically it is classified as minor ulcers, major ulcers and herpetiform ulcers. This article insights the current trends in management of this commonly occurring disease. Keywords:Recurrent Aphthous Stomatitis, Oral ulcers, Etanercept, Autoimmune diseases

The defeat of the oral mucosa in herpetiform Dhring dermatitis is a rare pathology. According to the literature, it is detected in 9.6% 10% of cases. Granular deposits of immunoglobulin A in the papillae of the dermis in herpetiform Dhring dermatitis are associated with gluten enteropathy, lead to the development of inflammatory processes on the skin and oral mucosa and the appearance of polymorphic itchy rashes and chronic recurrent course of the disease. The article describes a clinical case of a patient diagnosed with herpetiform dermatitis, manifestations in the oral cavity (ICD-10 L13.0X code). The need for a multidisciplinary approach to the diagnosis, differential diagnosis, treatment and dynamic observation of isolated lesions of the oral mucosa in herpetiform Dhring dermatitis is indicated. A scheme of measures required by a dentist is developed.

We conducted an integrative review on oral manifestations in patients with COVID‐19 based on the current available literature evidence. A bibliographic search was carried out on March 11, 2021, among published studies in the years 2019–2021 in the PubMed database and based on the search strategy (“COVID‐19” AND “oral lesions” OR “oral mucositis” OR “oral manifestation”). After applying the inclusion and exclusion criteria, 29 articles were considered suitable for this review. A total of 110 cases of patients with COVID‐19 who had oral manifestations were reported. The presence of ulcerated lesions was the most common finding, having a herpetiform and aphthous clinical pattern observed in most cases. Macules, petechiae, hemorrhagic blisters, pustular enanthem, mucositis, and halitosis were also among the most frequently described oral manifestations. The tongue was the most commonly affected site, followed by the palate and lip. Most of the reported cases were diagnosed only by the clinical aspect of the lesion associated with a positive SARS‐CoV‐2 test or the presence of other COVID‐19 symptoms. Current scientific evidence still could not affirm that most of the oral lesions observed in patients with COVID‐19 are related to the virus's direct or indirect action on the oral mucosa. To confirm this association, prospective and longitudinal studies are further needed, together with a larger number of patients, complemented by histopathological examination of these lesions. Additionally, molecular techniques, such as immunohistochemistry and in situ hybridization, may be necessary to perform the differential diagnosis with other oral lesions.

Numerous oral manifestations of COVID-19 have been reported in the literatures. Common oral lesions in COVID-19 patients included ulcerations, xerostomia, dysgeusia, gingival inflammation, and erythema. Among them, oral ulceration is the most frequent finding and is present as various but distinct patterns. Thus, we conducted a comprehensive review of 51 COVID-19 patients with oral ulcerative lesions to further analyze the various oral ulcerative lesions in COVID-19 patients. There were a median age of 41.4 years and a slight female predilection in these patients. Most oral lesions manifested as an aphtha-like ulceration but lack of an evidence of recurrent aphthous stomatitis. Some of them were present as herpetiform ulcerations without HSV infection. Widespread ulcerations accompanied with necrosis were observed in the more severe and immunosuppressed older patients. Although some reported patients were asymptomatic, most of them had systemic symptoms concurring or slightly preceding the oral ulcerative lesions and the latency from the onset of systemic symptoms to oral ulcerative lesions were under 10 days, suggesting that oral ulceration was one of the early symptoms of COVID-19. Therefore, the oral ulcerative lesions may be considered as oral markers for early diagnosis of the underlying COVID-19 infection in the asymptomatic patients.

Linear IgA bullous dermatosis (LABD) is a rare autoimmune bullous disease characterized by linear deposition of IgA along the cutaneous basement membrane. Clinically, LABD has a variable presentation characterized by tense vesiculobullous lesions on the trunk and extremities that often appear in a herpetiform arrangement or at the center of annular erythematous plaques. Omalizumab (Xolair; Genentech, South San Francisco, CA) is a monoclonal anti–immunoglobulin E (IgE) antibody that has been approved for chronic idiopathic urticaria (CIU). To date, omalizumab has not been reported to be of benefit in the treatment of LABD. However, omalizumab has been reported to improve control of other bullous dermatoses, particularly bullous pemphigoid.1

Pemphigus herpetiformis (PH), a rare type of pemphigus, is characterized by immunologic findings consistent with pemphigus but with a unique clinical and pathologic presentation. PH was first described as resembling dermatitis herpetiformis clinically, but because of its variable presentation, it can also resemble linear immunoglobulin A bullous dermatosis and bullous pemphigoid. We reviewed reported cases to analyze the most frequent clinical, pathologic, and immunologic characteristics and to propose corresponding diagnostic criteria. Through a comprehensive review of Medline and PubMed databases, 96 publications and 158 cases were identified. After reviewing the reported characteristics of PH, we suggest the following diagnostic criteria: Clinical: 1) pruritic herpetiform intact blisters with/without erosions; and/or 2) pruritic annular or urticarial erythematous plaques with/without erosions; Pathologic: 1) intraepidermal eosinophils or neutrophils, or both; and/or 2) intraepidermal split with/without acantholysis; Immunologic: 1) direct immunofluorescence showing immunoglobulin G with/without C3 intercellular deposits; and/or 2) indirect immunofluorescence showing immunoglobulin G to epithelial cell surface; and/or 3) detection of serum autoantibodies against desmogleins (1,3) or desmocollins (1,2,3), or both. Diagnosis requires one clinical, one pathologic, and one immunologic feature. We also report three new cases diagnosed at our institution to demonstrate the applicability of the suggested criteria.

Silver nanoparticles (AgNPs) were synthesized by a chemical reduction method. The particles were synthesized using silver nitrate solution with sodium borohydride as the reducer. The resulting colloidal AgNPs were characterized by UV-Visible spectroscopy, and FTIR. Aphthous stomatitis is a common and recurrent painful disease of the oral mucous membrane, classified in to three different aphthous types: minor, major and herpetiform. It may appear due to a variety of causes including: stress, food, hypersensitivities, infection, trauma, drug allergy, nutrition deficiencies (Iron, zinc & vitamin B12) or it could be a symptom of serious disease such as carcinoma. In this study, (75) young Iraqi patients aged (18-24) years divided in to two groups according to their gender (25 male and 50 female) all of them are suffering from major Aphthous ulcers in the mouth. The solution of (10 µg/ml) concentration of silver nanoparticles showed a uniform cycle inhibition around the ulcer growth zone while, increasing of (AgNPs) solution to (20 µg/ml) showed a highly and significant inhibitory effect against isolates from Aphthous stomatitis during the first 24 hours only in both male and female groups. Further studies is needed to investigate the inhibitory mechanism of (AgNPs) against Aphthous stomatitis.

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Background: Recurrent aphthous stomatitis (RAS) is a global oral case that stay incompletely understood yet. It was classified into three main types of minor, major or herpetiform, based on clinical features, but the exact causative agent is unknown, therefore treatments are primarily should be experimental and aimed at decrease symptoms rather than remedy or prevention. The aim of study is to detection of Herpes simplex virus-1 and Herpes simplex virus-2 in saliva of patients with recurrent aphthous stomatitis (RAS) as a causative agents of the disease by the enzyme-linked immunosorbent assay (ELISA) assay, and correlation between positive results and finding of age, gender, and family history. Materials and Methods: Study group of (40) saliva samples were taken from 40 patients with RAS lesions included 15 male and 25 female, with mean age at (34) years, at range about (18-55) years , and healthy control group were (20) healthy volunteers were suffered from oral traumatic ulcers, consist women (13), men (7), mean age (33) years in range (18-55). for detection of HSV viruses types that may causes this disease, and healthy control group were (20) healthy volunteers were suffered from oral traumatic ulcers, ELISA method used for diagnosis HSV-1 and HSV-2, from saliva samples of the patients with (RAS) with correlation between positive results and finding of age, gender, and family history. Results: Diagnostic specimens were consisted of two groups, study group of (40) saliva samples taken from 40 patients with RAS lesions. The results of ELISA to detect HSV had high significant (17): 42.5% from (40) patients with (RAS), HSV-1: (13)32.5%, and HSV-2: (4)10%. Conclusion: This high number of RAS cases by HSV, and presence of HSV-2 in patients saliva in this study acted important cause of prevalence of this disease in Iraq, were in age group (18-25) mostly in female especially in those with family history of infection. Keywords: Recurrent Aphthous Stomatitis (RAS), Aphthous ulcer, HSV-1&2 viruses, ELISA method

Genital ulceration can be a source of tremendous stress to the patient, as well as to the family members, and poses a difficult and sensitive diagnostic conundrum for the clinician. Cultural taboos and social stigmas related with the disease often result in the clinician not believing the patient’s version of history and basing the diagnosis entirely upon the clinical picture, aided by diagnostic tests. The clinicians should keep in mind that sexually transmitted infections (STIs), which can cause genital ulceration are very common, but there is a long list of non-sexually acquired causes of genital ulceration, which can lead to a diagnostic dilemma, and these should be considered before labelling the patient as suffering from a STI. We present a rare case of herpetiform genital aphthous ulcers mimicking herpes genitalis and chancroid, which was misdiagnosed repeatedly, and their effective response to treatment with colchicine on subsequent identification of the correct diagnosis.

Pemphigus vulgaris is the most common type of pemphigus with mucocutaneous and mucosal variants Pemphigus foliaceus presents with superficial flaccid blisters and scales with anti desmoglein 1 antibody Pemphigus vegetans presents with vegetative and papillomatous lesions and pemphigus herpetiformis with grouped and herpetiform small blisters, without papillary dermal antidesmogelin 1 antibody deposits Paraneoplastic pemphigus is associated with underlying malignancy and more severe painful oral lesions Drug-induced types of pemphigus may be triggered by exposure to thiol drugs, such a D-penicillamine and captopril, phenol drugs, or non-thiol non-phenol drugs such as peniciline and cephalosporines

We report a unique case of a Japanese woman with herpetiform pemphigus (HP) who had IgG autoantibodies reactive with nondesmosomal sites of keratinocytes and presented characteristic transmission electron microscopic (TEM) findings of various-sized vacuoles in keratinocytes without acantholysis. The patient presented with pruritic annular oedematous erythemas with small blisters lining the margins on the trunk and extremities. Histopathological examinations showed intraepidermal blisters with prominent infiltrations of eosinophils. Direct and indirect immunofluorescence tests revealed the presence of in vivo bound and circulating IgG autoantibodies to the keratinocyte cell surfaces. However, enzyme-linked immunosorbent assays for desmoglein (Dsg) 1, Dsg3 and desmocollins 1-3 showed negative results. Immunoblotting using the full-length human Dsg1 recombinant protein showed a positive band. TEM examination showed various-sized vacuoles squashing the nuclei in many keratinocytes, resulting in rupture of the cells. Immunoelectron microscopic examination revealed IgG deposition over the entire keratinocyte cell surfaces, which spared the desmosomes. IgG antibodies were also present on the inside walls of the vacuoles around the nuclei of keratinocytes and on the cell surfaces of infiltrating eosinophils. This patient also had marked eosinophilia and high levels of thymus and activation-regulated chemokine and interleukin-5 in the serum. These results indicated a novel autoantigen on the nondesmosomal keratinocyte cell surfaces and the pathogenesis of bullous spongiotic change with inflammation in HP.

Background: Recurrent aphthous stomatitis consists of the presence of abrasions or ulcerations located on mucosae (oral or genital). Objectives: The aim of this article is to review the current literature providing the main causes related to recurrent aphthous stomatitis and insights into treatment and management of this clinical condition Methods: Articles matching terms that correlated with “recurrent aphthous stomatitis” were searched on PubMed, EMBASE, and Cochrane Library and selected according to their pertinence. Results: Several forms of aphthous stomatitis have been described, based on the extent (minor, major), morphology (herpetiform), and associations to other signs (Behçet syndrome or more complex inflammatory syndromes). Topical as well as systemic treatments have been described to obtain a faster remission of the aphthosis or to reduce associated symptoms such as pain. Conclusions: Recurrent aphthous stomatitis can have a mild-to-severe clinical appearance, being mainly localized on the oral mucosa or at the level of the genital area. Different strategies have been described so far for its management and treatment.

Introdução: A dermatite herpetiforme (DH) é uma manifestação benigna, crônica e inflamatória da pele. As lesões são erupções eritêmato- pápulo- vesiculosa, pruriginosas, simétricas, dispostas de forma herpetiforme, tendo afinidade por superfícies extensoras. Há predileção pelo sexo masculino, entre 30 e 40 anos e está relacionada com anormalidades na mucosa do intestino delgado e ao depósito de IgA na derme papilar. Tem origem multifatorial, abrangendo componentes genéticos, ambientais e imunológicos. Objetivos: Analisar a aplicação dos conhecimentos obtidos pela revisão integrativa abordando a dermatite herpetiforme e doença celíaca (DC) para elaboração de um raciocínio clínico frente ao diagnóstico precoce e tratamento efetivo. Metodologia: Artigos científicos e de revisão publicados e referenciados no MEDLINE, LILACS, IBECS, BINACIS, LIS, BRISA/RedTESA e MEdCArib foram consultados, delimitados de 2008 a 2019. Os livros “Tratado de dermatologia” de Belda Júnior e “Dermatologia” de Sampaio e Rivitti também foram incluídos. Resultados: O diagnóstico da DH é clinico, laboratorial e imunológico. A apresentação e atividade de erupção das bolhas é variável. O achado histopatológico clássico é uma fenda subepidérmica com neutrófilos e eosinófilos nas papilas dérmica, com infiltrado inflamatório misto perivesicular. A imunofluorescência direta da pele não envolvida é padrão ouro.O pilar do tratamento envolve uma dieta livre de glúten associado ao uso de medicamentos, sendo observada a remissão incompleta frequente em pacientes que não restringem o glúten. Conclusão: O conhecimento das manifestações clínicas e subclínicas da DH e DC assim como achados laboratoriais são cruciais ao diagnóstico precoce, corroborando para afastar diagnósticos errôneos, exacerbações ou complicações.

The article describes the case of acquired bullous epidermolysis in a woman of 45 years old, suffering from a disease from 2.5 years. As a child, she was diagnosed with herpetiform dermatitis on the base of a clinical picture and histological data. After the period of puberty, when in addition to skin blistering a lesion of the oral mucosa, dystrophy and absence of nail plates, contracture of the 2 fingers of the hands arose, the diagnosis was changed to dystrophic congenital bullous epidermolysis, which did not contradict with re-histological examination of the skin. In order to clarify the diagnosis, another biopsy of the leg skin was performed in 2016. The light microscopy data corresponded to the herpetiform dermatitis or vesicular form of the bullous pemphigoid, the acquired bullous epidermolysis was not also excluded. Indirect RIF allowed to reject the diagnosis of herpetiform dermatitis. The possibility of bullous pemphigoid developing on the background of preexisting congenital bullous epidermolysis was investigated by immunofluorescence mapping with antibodies to 13 structural proteins of the dermo-epidermal junction. Expression of all the studied proteins corresponded to that of healthy individuals, which conflicted with the diagnosis of congenital bullous epidermolysis. Additional immunofluorescence study of the sites of spontaneous cleavage of the biopsy specimen, as well as of n- and u-patterns in the structure of the luminescence line, made possible to exclude the bullous pemphigoid. So, the use of a complex of immunomorphological methods helped to establish the correct diagnosis.

Background Herpes zoster (HZ) is a cutaneous viral infection of the skin that presents in a dermatomal distribution. It represents reactivation of herpes varicella zoster virus that has continued to exist in a latent form in the neurons of the posterior root ganglia. Although it is rare to see HZ in children, cases have been reported after exposure to varicella zoster in utero or during the first months of life. Objective The purpose of this report is to present a case of herpes zoster in a 2-month-old infant, conservatively managed without oral antivirals, and its 5 years follow-up, demonstrating no sequelae or recurrences. Case report A 2-month-old female infant presented with skin lesions in the chest. His mother developed a varicella infection 20 days before delivery. The child was asymptomatic at birth. Physical exam noted a fever and skin lesions made of grouped vesicles on erythematous plaques. The characteristic herpetiform lesions distributed in the dermatome of the left hemi chest. The infant was treated by only local antiseptic treatment. The lesions were completely resolved in 2 weeks. After 5 years of follow-up the child has no sequelae, such as postherpetic neuralgia, or recurrence. Conclusion After maternal varicella during pregnancy, herpes zoster may occur in the first year of life in a completely asymptomatic child at birth proving in utero infection. The presentation of the rash is characteristic; but otherwise, the condition differs from that in adults in that it is mild and not associated with postherpetic neuralgia. In uncomplicated cases, conservative treatment measures support the quick resolution with no sequelae.

Oral health is a pivotal sign of overall health, well-being, and quality of life. With the emergence of COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), insights into the relationship between SARS-CoV-2 and oral diseases are urgently needed to elucidate the oral manifestations of SARS-CoV-2. The current review aims at analyzing various reports available on oral symptoms along with possible causation, their relationship to the time of occurrence of clinical symptoms, and to shape guidelines for dental practices that could help in combating this global pandemic. The common symptoms that patients report to the dental office even at the presymptomatic stage are ageusia (loss of taste), non-specific anosmia (loss of smell—not associated with rhinitis), and hyposalivation. Few studies also report unexplained ulcers in the oral cavity, desquamative gingivitis, herpetiform ulcers on attached gingiva, blisters/irregular ulcers on the tongue's dorsal surface enlargement of submandibular glands, and cervical lymph node enlargement. Dental surgeons should abide by the prevalent precautionary guidelines. They are at very high risk due to their close contact with patients and exposure to saliva and blood during treatment.

Background Epidermolysis bullosa simplex (EBS) is a rare genodermatosis resulting from multiple gene mutations, including KRT5 and KRT14. The clinical expression of the mechanobullous skin fragility disease has not been fully explained by the genotype. Case Description An 11-day-old Japanese newborn infant was hospitalized because of herpetiform skin blistering on the feet, which expanded systemically after birth. There was no evidence of virus infection. The biopsied skin lesion showed a blister on the lamina densa without keratin clumps, indicating a diagnosis of EBS-generalized intermediate. We punctured the blisters to remove the contents daily, which led to no exacerbation or infection. The genetic study determined that the patient carried double substitutions of KRT5 c.1424A > G (p.E475G) and KRT14 c.1237G > A (p.A413T). The asymptomatic mother and sister carried the KRT14 substitution, but the healthy father had no substitution of the KRT gene. Conclusion This is the first report of EBS-generalized intermediate in a newborn with de novo KRT5 gene mutation and KRT14 gene polymorphism, and no familial history of epidermolysis. Neonatal blistering due to EBS requires optimal skin management after excluding infectious and immunobullous diseases.

Pemphigus herpetiformis is an autoimmune blistering disease. We report a case of pemphigus herpetiformis, a generalized form, manifested as pruritic grouped vesicles at extremities and trunk, in a seventy years old man. Neutrophil dominant inflammatory substrate was seen in histopathology. Direct immunofluorescene revealed IgG reactivity in net like pattern at upper epidermis, confirming pemphigus. The patient responded well to prednisolone and colchicine combination initially and maintained remission later on colchicine alone. Colchicine has anti-mitotic, anti-inflammatory and immunosuppressive mechanism of actions and proven benefits in neutrophilic dermatoses. Therefore we recommend colchicine as mono therapy or in combination with immunosuppressive, for the treatment of pemphigus herpetiformis where neutrophil is predominant inflammatory infiltrate histologically.NJDVL Vol. 13, No. 1, 2015 Page: 61-65

Pemphigus herpetiformis is an autoimmune bullous disease considered an infrequent variant of pemphigus. It is characterized by clinical findings of dermatitis herpetiformis with immunopathological features of pemphigus. We report the case of a 33-year-old woman with dermatosis on the scalp, trunk and upper and lower extremities presenting as circular plaques with vesicles in a herpetiform pattern, white scale and yellowish crusts. Histopathological and direct immunofluorescence findings were compatible with pemphigus. The patient was treated with dapsone and prednisone, with significant improvement. This presentation is uncommon, and the clinical course differs from that of pemphigus vulgaris.

Dermatitis herpetiformis, a specific cutaneous manifestation of Celiac disease, is characterized by herpetiform clusters of pruritic urticated papules and vesicles on the skin and granular IgA deposits in the dermal papillae. In the present report, we describe a case of 39-year old male who is previously diagnosed as DH, and after this diagnosis he was serologically and histologically confirmed to have CD. [Med-Science 2020; 9(4.000): 1083-5]

Background Autoimmune bullous dermatoses (AIBDs) in children are uncommon, and their long-term evolution remains unknown. Objective The aim of this retrospective study was to characterize the long-term prognosis of AIBDs that started during childhood. Methods We conducted a monocentric retrospective study, in the French dermatology centre, by including all children affected by AIBDs. The long-term outcome was obtained through a phone call questionnaire. Results Sixty-three patients were included from January 1993 to December 2015, 34 female and 29 males: 27 Linear immunoglobulin A disease (LAD), 12 bullous pemphigoid (BP), 12 pemphigus, 8 herpetiform dermatitis (DH) and 4 epidermolysis bullosa aquisita (EBA). The mean age was 4.7 years old. Twenty-five patients were lost during the follow-up. For the 38 remaining patients, the mean follow-up duration for all pathologies was 6.6 years. Twenty-nine of them had at least one relapse. Late relapses were observed in two cases of DH and six cases of pemphigus (7-34 months). The mean treatment duration was 30.6 months with variability according to the AIBDs. Topical corticosteroids were used alone, effectively, for seven patients and in association with other treatment in 19 patients in complete remission. Complete remission was noted in 34/38 children with a follow-up of 4.4 years (0.08-19.5). The mean duration to complete remission was 30.5 months (6-114 months). Late nasal synechiae were reported in one EBA only. There was no significant associated comorbidity, but an association with a primary immune deficiency (PID) was observed in two cases. Conclusion Childhood AIBDs appear to be of good overall prognosis but a long-term follow-up is mandatory, as relapses can be late, except for BP. The use of topical corticosteroids is frequently effective alone or in association. The association with PID leads to think about the possibility of a possible underlying dysimmunity in the child.

Linear IgA bullous dermatosis (LABD) is an acquired IgA autoimmune blistering disease characterized subepidermal tense bullae in an annular (or less commonly herpetiform or linear) arrangement. LABD is due to circulating IgA antibodies that target the basement membrane zone, specifically 97 kDa antigen portion of bullous pemphigoid antigen 2 (BP180). An adult and childhood variant exist (chronic bullous disease of childhood-CBDC) of which the etiology is unknown.

Aim To evaluate the clinical behavior of reccurent aphtous stomatitis (RAS) in a Cuban population. Methods In the present study adult patients from the Vedado's University Polyclinic (Cuba) diagnosed with RAS, from September 2009 to May 2010, were examined. Clinical classification, site, associated predisposing factors and clinical evolution of aphthae were evaluated. All patients were reevaluated at 10 and 14 days after the diagnosis to analyze the healing process. Results Minor aphthae was the more frequent clinical variant of RAS (88.4%) followed by Major (8.4%) and Herpetiform (3.2%) aphthae. Females were more affected (67.4%) than males (22,6%). Major aphthae was more common in patients aged between 35 and 59 years old, however Minor and Herpetiform aphthae were more common in individuals aged between 19 and 34 years old. Stress was a possible predisposing factor for the development of RAS in all patients. The most frequent site affected was the lip (35.7%) and the least was the palate (7.8%). Aphthae healing period was 7–10 days in 90.5% of the studied population. Conclusion The most common clinical variant of RAS in the population studied was the Minor form, affecting mainly the female gender and the younger age groups, with a healing period time between 7 and 10 days. The labial mucosa was the most common site.

Recurrent aphthous stomatitis (RAS) is an inflammation of the soft tissues of the mouth that is characterized by recurrent ulcers. SAR is clinically divided into three types, ie recurrent aphthous stomatitis minor, major and herpetiform. Clinical features of minor types usually with a diameter of about 2-4 mm with yellow-gray base and surrounded by an erythematous halo, affects mainly the non-keratinized mobile mucosae such as lips and tongue, a few ulcers (1-5) or multiple at a time, minor ulcers usually heal within 10-14 days without scarring. Early lesions on the SAR is usually felt by people as burning, followed by extremely pain. The aetiology of RAS is unknown, but associated with a variety of predisposing such as menstrual cycle and trauma. Case management is topical steroids, topical antiseptic and vitamins C to relieve the symptoms and fasten healing. Keywords: minor ulcer, multiple, recurrent aphthous stomatitis

Recurrent aphthous stomatitis (canker sores) is a very common oral condition that remains incompletely understood. Presentation has been well-classified into minor, major or herpetiform subcategories based on clinical features, but exact etiology is unknown. Because etiology is unclear, treatments are primarily empiric and aimed at symptom reduction rather than prevention or cure. However, there are several methods, both topical and systemic, that can be easily and affordably utilized in the primary care setting. (J Patient-Centered Res Rev. 2014;1:197-200.)

We describe the lymphoscintigraphy findings of a 25-year-old female patient who was undergoing presurgical workup for lymphangiomas of the vulva. She had a history of treatment for disseminated tuberculosis 6 years back and presented with herpetiform oozing vesicles in the external genitalia. Single-photon emission computed tomography/computed tomography (SPECT/CT) confirmed cutaneous tracer accumulation in the vulval lesions and demonstrated the presence of densely calcified inguinal nodes secondary to healed tuberculosis as the etiology of secondary lymphangioma.

Recurrent aphthous stomatitis (RAS) is a chronic, ulcerative disease with a probable polygenic mode of inheritance and complex etiology with a strong immunological background. The aim of the present study was to determine the possible association between two single nucleotide polymorphisms (SNPs) of the IL-1β gene: IL-1β-511 TC (rs16944) and IL-1β+3954CT (rs1143634) and RAS susceptibility in a moderately large group of patients.One hundred and four patients with minor, major and herpetiform RAS and 75 healthy volunteers were genotyped at IL-1β-511 TC (rs16944) and IL-1β+3954CT (rs1143634) using the PCR-RFLP approach. The results were statistically analysed with chi-square test and test of difference between two rates of structure, with p0.05 assumed to be a statistically significance level (Statistica 10, StatSoftThere were no statistically significant differences in the genotype distribution for the IL-1β C[+3954]T polymorphism between the RAS and control groups. The frequency of IL-1β*T[-511]/*T[-511] homozygotes among the patients was significantly higher when compared to our study control (p0.0347). The results after stratification into carriers and non-carriers of C and T alleles did not clearly indicate which SNP may be considered a risk factor for RAS.The genetic association between the studied SNPs of the IL-1β gene and RAS remains controversial and requires further investigation.

BACKGROUND: Linear IgA bullous dermatosis (LABD) is an autoimmune blistering skin disorder characterized by linear IgA deposits along the dermoepidermal junction. Usually idiopathic, LABD can be drug-induced. OBJECTIVE: To report the atypical characteristics of a case of trimethoprim-sulfamethoxazole-induced LABD presenting as toxic epidermal necrolysis (TEN). METHODS: A 63-year-old woman treated with trimethoprim-sulfamethoxazole for Pneumocystis jirovecii infection developed a generalized maculopapular rash with herpetiform lesions, rosette-like lesions, and tense bullae with Nikolsky sign. RESULTS: Anti-basement membrane zone antibodies were negative, but immunoblot revealed a 160 kDa band corresponding to subepidermal class IgA desmoglein 1. Skin biopsy specimens revealed a subepidermal bulla and direct immunofluorescence showed linear IgA deposition along the basement membrane zone. A diagnosis of toxic epidermal necrolysis was excluded and replaced by trimethoprim-sulfamethoxazole-induced LABD. CONCLUSION: We report a case of trimethoprim-sulfamethoxazole-induced LABD with a 160 kDa IgA desmoglein 1 found by immunoblotting analysis, probably by epitope spreading.

Pityriasis Rosea (PR) is a common skin disorderencountered in daily practice. Although its etiologyhas not been established, there has been widespreadresearch into possibilities. The lack of its characteristicmanifestations, specifically the herald patch andtruncal involvement, can lead to pitfalls in diagnosis.Whereas other conditions in the differential diagnosisshould be considered, PR can at times also manifest inan atypical manner. We wish to illustrate three casesof PR including those that presented with aphthousulcers, vesicles, and an inverse pattern.

Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases in many parts of the world. However, there is very limited published clinical evidence for the therapies used in this condition. This could be partly due to the difficulty in evaluating the efficacy of oral ulcer treatment objectively. In this paper, we present a method for assessing and monitoring the severity of oral ulcers before and after treatment.Six ulcer characteristics, number, size, duration, ulcer-free period, site and pain, were used to generate an ulcer severity score (USS). The scores for 223 RAS patients were determined, and 79 were scored again after 3-month therapy with topical betamethasone.The scores for the minor RAS group were between 18 and 43 (mean 29.2 ± 5.3). The mean score in the major ulcers group (range: 28-60, mean 39.9 ± 6.1) was significantly greater than in the minor group (P 0.001). The herpetiform recurrent ulcers score range was wide (range: 18-57, mean 36.6 ± 8.4). The mean severity score decreased significantly after treatment (P 0.001).The USS was indicative of the disease activity in recurrent oral ulceration. It helped in assessing the efficacy of therapy, as the change in the numerical score reflected the change in ulcer severity in response to treatment. This tool may well prove to be of value in clinical management, research and in clinical trials.

A 68-year-old woman presented with unilateral herpetiform skin lesions of the face. She also showed reduced eye lid and mimic function as well as hearing loss. In addition grouped vesicles were seen in the outer ear canal. We diagnosed Ramsay Hunt syndrome and administered intravenous acyclovir, prednisolone and pentoxifylline. Within a few weeks, there was complete remission including the neurological symptoms.

• A non-invasive diagnostic method based on reverse transcription-polymerase chain reaction has been developed for patients with herpes simplex virus or varicella/herpes zoster virus infections, and hydroa vacciniforme.

Richner-Hanhart syndrome (RHS, tyrosinemia type II) is a rare, autosomal recessive inborn error of tyrosine metabolism caused by tyrosine aminotransferase deficiency. It is characterized by photophobia due to keratitis, painful palmoplantar hyperkeratosis, variable mental retardation, and elevated serum tyrosine levels. Patients are often misdiagnosed with herpes simplex keratitis. We report on a a boy from Brazil who presented with bilateral keratitis secondary to RHS, which had earlier been misdiagnosed as herpes simplex keratitis.