Blistering Conditions

Question 1

Blistering condition with mucosal involvement

Answer 1

Pemphigus vulgaris

Question 2

Blistering condition withOUT mucosal involvement

Answer 2

Bullous Pemphigoid (Mouth is spared)

Question 3

Which conditions are immunobullous?

Answer 3

Bullous pemphigoid

Pemphigus vulgaris

Question 4

7 common conditions causing blisters

Answer 4

Impetigo
Herpes zoster virus
Herpes simplex virus
Insect bites
Acute contact dermatitis
Pompholyx
Burns

Question 5

Which rare genetic condition involves blistering of the skin?

Answer 5

Epidermolysis bullosa

Question 6

Describe the prodromal phase of bullous pemphigoid

Answer 6

Pruritic, eczematous, papular, or urticaria-like skin lesions

Question 7

4 features of lesions in bullous pemphigoid

Answer 7

Tense bulla on an erythematous, urticarial, or noninflammatory base
Numerous + widespread
Symmetrical
Favour flexural extremities, lower trunk, + abdomen.

Question 8

What happens if a blister bursts in bullous pemphigoid?

Answer 8

Moist eroded crusty areas slowly heal

Leave post-inflammatory hyperpigmentation.

Question 9

Population commonly affected by bullous pemphigoid

Answer 9

Elderly

Question 10

Aetiology of bullous pemphigoid

Answer 10

Autoantibodies against antigens between epidermis + dermis causes sub-epidermal split in skin

Question 11

Dx of bullous pemphigoid

Answer 11

Biopsy

Question 12

Tx for bullous pemphigoid

Answer 12

Topical clobestol (limited)
Prednisolone PO (severe/ widespread)
Antihistamines for itch
Abx for steroid sparing in long term

Question 13

Population commonly affected by pemphigus vulgaris

Answer 13

Middle aged

Question 14

3 features of mucosal involvement pemphigus vulgaris

Answer 14

Oral cavity often initial site (+ most common)
Blisters erode quickly, leave erosions
Painful- difficulty eating, weight loss, + malnutrition.

Question 15

4 features of skin lesions in pemphigus vulgaris

Answer 15

Flaccid blisters
On normal-appearing or erythematous skin
Rupture easily, painful erosions bleed easily
Palms + soles often spared

Question 16

Which sign may be seen in pemphigus vulgaris?

Answer 16

Nikolsky sign

elicitation of skin blistering as a result of gentle mechanical pressure on the skin

Question 17

Ix for pemphigus vulgaris

Answer 17

Biopsy

Question 18

Tx for mild pemphigus vulgaris

Answer 18

Prednisolone PO +/- Azathioprine PO

Rituximab IV +/- Prednisolone PO

Question 19

Tx for moderate-severe pemphigus vulgaris

Answer 19

Rituximab IV +/- Prednisolone PO

Prednisolone PO +/- Azathioprine PO (if Rit CI)

Question 20

3 epidemiological/ aetiological features of dermatitis herpetiformis

Answer 20

Coeliac disease
Often early adulthood
Deposition of IgA in dermis

Question 21

3 features of presentation in dermatitis herpetiformis

Answer 21

Itchy extensor surfaces
Symmetrically distributed papules + vesicles
Gluten sensitive arthropathy

Question 22

Ix for dermatitis herpetiformis

Answer 22

Skin biopsy

Question 23

Tx for dermatitis herpetiformis

Answer 23

GF diet

+/- Abx: Dapsone PO