[24] Blistering Skin Disorders

Question 1

How can blistering skin conditions be divided?

Answer 1

• Immunobullous diseases
• Blistering skin infections
• Other

Question 2

What are some examples of immunobullous diseases?

Answer 2

• Bullous pemphigoid
• Pemphigus vulgaris

Question 3

Give examples of blistering skin infections

Answer 3

• Herpes simplex
• Bullous impetigo

Question 4

What is an example of an ‘other’ blistering skin condition?

Answer 4

Porphyria cutanea tarda

Question 5

What does the fragility of blisters depend upon?

Answer 5

The level of split within the skin

Question 6

What are two levels at which the skin can split to form a blister?

Answer 6

• Intra-epidermal
• Sub-epidermal

Question 7

What is an intra-epidermal skin split?

Answer 7

A split within the epidermis

Question 8

What is a sub-epidermal skin split?

Answer 8

A split between the dermis and epidermis

Question 9

Which type of skin split makes for more fragile bilsters?

Answer 9

Intra-epidermal split

Question 10

What are some of the more common causes of blisters?

Answer 10

• Impetigo
• Hepres simplex
• Herpes zoster
• Acute contact dermatitis
• Pompholyx
• Burns

Question 11

What is pompholyx?

Answer 11

Vesicular eczema of the hands and feet

Question 12

What does the rest of this deck concern?

Answer 12

Immunobullous diseases

Question 13

What is bullous pemphigoid?

Answer 13

A blistering skin disorder which usually affects the elderly

Question 14

What is the underlying pathology in bullous pemphigoid?

Answer 14

Autoantibodies against antigens between the epidermis and dermis causing a sub-epidermal split in the skin

Question 15

What is the main presenting symtpom in bullous pemphigoid?

Answer 15

Tense, fluid filled blisters on an erythematous base

Question 16

Are bullous pemphigoid lesions itchy?

Answer 16

Often can be

Question 17

What may precede the blisters of bullous pemphigoid?

Answer 17

A non-specific itchy rash

Question 18

Where does bullous pemphigoid usually affect?

Answer 18

The trunks and limbs

Question 19

What general measures shoudl be taken to manage bullous pemphigoid?

Answer 19

• Wound dressings
• Monitor for signs of infection

Question 20

How should localised bullous pemphigoid be managed?

Answer 20

Topical steroids

Question 21

How can widespread bullous pemphigoid be managed?

Answer 21

• Oral steroids
• Oral tetracycline and nicotinamide
• Immunosuppressive agents

Question 22

What immunosuppressive agents can be used to manage widespread bullous pemphigoid?

Answer 22

• Azathioprine
• Mycophenolate mofetil
• Methotrexate

Question 23

What is pemphigus vulgaris?

Answer 23

A blistering skin condition which usually affect the middle-aged

Question 24

What is the underlying pathophysiology of pemphigus vulgaris?

Answer 24

Autoantibodies against antigens within the epidermis causing an intra-epidermal split in the skin

Question 25

What is the main presenting symptom of pemphigus vulgaris?

Answer 25

Flaccid, painful, easily ruptured blisters forming erosion and crusts

Question 26

What does pemphigus vulgaris causes alongside (and sometimes preceding) skin lesions?

Answer 26

Mucosal lesions

Question 27

What are the general measures for managing pemphigus vulgaris?

Answer 27

* Wound dressings if required * Monitor for infection * Good oral care (if oral lesions)

Question 28

What oral therapies can be used to manage pemphigus vulgaris?

Answer 28

* High-dose oral steroids * Immunosuppressive agents

Question 29

What immunosuppressive agents can be used in pemphigus vulgaris?

Answer 29

* Methotrexate * Azathioprine * Cyclophosphamide * Mycophenolate mofetil