1. Cicatricial pemphigoid

2. Stevens-Johnson syndrome

3. Toxic epidermal necrolysis (Lyell disease)

4. Epidermolysis bullosa

5. Pemphigus vulgaris

6. Linear IgA bullous dermatosis

IMMUNOBULLOUS DISEASES

Cicatricial pemphigoid• Chronic and progressive• Typically affects elderly women• Increased prevalence of HLA-B12

Oral mucosal lesions in most cases Skin lesions are less common

Progression of ocular cicatricial pemphigoid

Diffuse hyperaemia

Subepithelial fibrosis and shrinkage Symblepharon

Pseudomembrane formation

Complications of ocular cicatricial pemphigoid

Ankyloblepharon

Corneal keratinization

Metaplastic lashes Cicatricial entropion

Total obliteration of fornices Secondary bacterial keratitis

Stevens-Johnson syndrome• Acute, and self-limiting• Hypersensitivity to drugs or infection• Typically affects young men

Lesions of oral mucosa and lips

Maculopapules which may develop into target lesions

Vesciculobullous haemorrhagicand necrotic lesions

Ocular complications of Stevens-Johnson syndrome

Transient conjunctivitis and lid crusting without sequelae

Severe membranous or pseudomembranous conjunctivitis

Focal fibrotic patches andoccasionally symblepharon

Metaplastic lashes

Other immunobullous diseases (1)Toxic epidermal necrolysis

(Lyell disease)

• ‘Scalded’ skin lesions

• Conjunctivitis - common and similar to Stevens-Johnson syndrome

Epidermolysis bullosa

• Skin bullae and necrosis induced by minor trauma• Conjunctivitis - common and may result in scarring

Pemphigus vulgaris

• Flaccid, weeping bullae

• Conjunctivitis - uncommon and mild

Linear IgA bullous dermatosis

• Tense bullae of varying size

• Conjunctivitis - common and may result in scarring

Other immunobullous diseases (2)