Autoimmune Blistering Disorders

Question 1

What is bullous impetigo caused by?

Answer 1

staph

Question 2

How is bullous impetigo regular than regular impetigo?

Answer 2

• Bullous is localized and one continuous vesicles

- Regular has the honey-colored crust

Question 3

How do you tell bullous impetigo from herpes?

Answer 3

Herpes will be multiple small vesicles (rather than one large vesicle)

Question 4

What is the real name for shingles?

Answer 4

herpes zoster virus (VZV)

Question 5

How do you differentiate shingles from allergic contact dermatitis?

Answer 5

Shingles are unilateral and dermatomal!

papules and plaques that progress to blisters

Question 6

What is dyshidrosis?

Answer 6

Form of atopic dermatitis with tapioca pudding vesicles on the sides of the fingers. Recurrent and extremely itchy.

Question 7

What is the differential for dyshidrosis?

Answer 7

Scabies

Question 8

What is a classic finding in scalded skin syndome?

Answer 8

-Perioral fissuring (erythema all over the mouth with scales)

Question 9

What is the real name for chicken pox?

Answer 9

Varicella zoster (VZV)

Question 10

What virus causes fever blisters?

Answer 10

HSV1

Question 11

What virus causes genital herpes?

Answer 11

HSV2

Question 12

What occurs with the first exposure of HSV-1?

Answer 12

Painful vesicles on labial mucosa and may have fever

Question 13

What occurs with eruptions of HSV-1?

Answer 13

Recurrent orolabial herpes localized area of vesicles on erythematous base

Question 14

What occurs with primary HSV-2?

Answer 14

Bilateral erosions, inguinal LAD

Rarely have aseptic meningitis

Question 15

How are recurrences of HSV-2 different than primary?

Answer 15

they are less severe

Question 16

How do people describe the morphology of chicken pox?

Answer 16

Dew drop on a rose petal (small single teardrop vesicles on erythematous base)

Question 17

What are some complications of chicken pox?

Answer 17

Bacterial pneumonia
ATaxia and encephalitis
Myocarditis
Hepatitis

Question 18

What is Reye syndrome?

Answer 18

Varicella, hepatitis, acute encephalopathy when symptoms of varicella are treated with aspirin in children

Question 19

What are some adverse effects of shingles?

Answer 19

Blindness
Bell’s Palsy
Encephalitis

Question 20

How do you treat HAV and VZV?

Answer 20

Acyclovir or Valacyclovir

dose depends on location, active lesions v. suppression, immunocompetence, etc.

Question 21

What is bullous pemphigoid?

Answer 21

autoantibodies to hemidesmosomes resulting in deep, tense bullae on an urticarial base.

Question 22

What is pemphigus vulgaris?

Answer 22

autoantibodies to desmogleins 1 and 3 resulting in superficial bullae and erosions.

Question 23

Where are hemidesmosomes located?

Answer 23

the dermal/epidermal junction

Question 24

Where are desmogleins located?

Answer 24

epidermis

Question 25

Who gets bullous pemphigoid?

Answer 25

65-75 year olds

Question 26

How do you diagnose bullous pemphigoid?

Answer 26

Linear IgG and C3 at dermoepidermal junction (Ab to BP230 and BP180) antigens at DEJ

Question 27

How do you treat bullous pemphigoid?

Answer 27

- Topical steroids - Systemic steroids - TCN/nicinamide - Myocphenolate Mofetil

Question 28

How can you tell if a blister is tense?

Answer 28

If you see a blister full of fluid (looks like it is about to pop)!

Question 29

What are located in the blisters of bullous pemphigoid?

Answer 29

eosinophils

Question 30

How does pemphigus vulgaris present?

Answer 30

Look like erosions all over (flaccid bullae)

Question 31

What is a unique clinical feature of pemphigus vulgaris?

Answer 31

Positive nikolsky | also seen in SJS

Question 32

Who gets pemphigus vulgaris?

Answer 32

adults in 40s-50s

Question 33

What is a unique diagnostic feature of pemphigus vulgaris?

Answer 33

"chicken-wire" pattern on DIF

Question 34

What may cause pemphigus vulgaris?

Answer 34

Genetic predisopsition Penicillamine Paranepolastic pemphigus

Question 35

How do you treat pemphigus vulgaris?

Answer 35

Oral steroids Mycophenolate mofetil Azathioprine Rituximab

Question 36

What is pemphigus foliaceus?

Answer 36

Antibodies against desmoglein 1 so that the skin is falling apart in very superficial epidermis and leaves scales that look like "corn flakes". Can cause erythroderma!

Question 37

How is pemphigus foliaceus different from pemphigus vulgaris?

Answer 37

- Only rare mucosal involvement - Not stemically ill - Only involve superficial layer - Only effects desmoglein 1

Question 38

How do you treat pemphigus foliaceus?

Answer 38

Steroids Mycophenolate mofetil Dapsone Anti-malarials

Question 39

What is linear IgA dermatosis?

Answer 39

Very similar to bullous pemphigoid, subepidermal, IgA lines up at dermal-epidermal junction

Question 40

What is the morphology of IgA dermatosis blisters?

Answer 40

"Flower-looking lesions" and string of pearls

Question 41

What are the two types of IgA dermatosis?

Answer 41

Childhood: chronic bullous disease of childhood Adult: most likely duet o medicine (linear IgA due to vancomycin)

Question 42

What is dermatitis herpetiformis?

Answer 42

Autoimmune bullous disorder associated with gluten sensitive enteropathy

Question 43

What are the key features of dermatitis herpetiformis?

Answer 43

Pruritic vesicles on extensor surfaces (ex. elbow). Won't see vesicles because they have scratched them all off

Question 44

What is the histology of dermatitis herpetiformis?

Answer 44

Subepideraml vesicles with neutrophils at DEF; DIF is granular IgA at dermal papillae

Question 45

What is the treatment for dermatitis herpetiformis?

Answer 45

Dapsone | Gluten free diet