Blistering Disorders

Question 1

Autoimmune blistering disease; generalized tense bullae; 20% involve mouth; intensely itchy (Pruritic)

Answer 1

Bullous Pemphigoid

Question 2

Elderly (Chronic); histology shows subepidermal bullae with eosinophils; DIF shows linear IgG and C3 at the basement membrane zone

Answer 2

Bullous Pemphigoid

Question 3

TX for Bullous Pemphigoid

Answer 3

potent topical steroids if localized; prednisone (Short term); steroid-sparing agents (Maintainance)

Question 4

Autoimmune blistering disease; generalized erosion with crusting; mouth always involved; erosion rather than blisters; Positive Nikolsky sign

Answer 4

Pemphigus Vulgaris

Question 5

Histology shows intraepidermal split (no eosinophils), DIF shows fishnet IgG and C3 in the epidermis

Answer 5

Pemphigus Vulgaris

Question 6

TX for Pemphigus Vulgaris

Answer 6

potent topical steroids if localized; prednisone (Short term); steroid-sparing agents (Maintainance)

Question 7

Autoimmune blistering disease; Highly associated with Celiac disease; IgA antibodies form against gliadin cross-linked to tissue transglutaminase; attract neutrophils into dermal papillae

Answer 7

Dermatitis Herpetiformis

Question 8

Tiny grouped vesicles, super itchy, symmetrical extensor distribution; Histology shows neutrophils in the dermal papillae; direct immunofluorescence shows IgA in the dermal papillae

Answer 8

Dermatitis Herpetiformis

Question 9

TX for Dermatitis Herpetiformis

Answer 9

Gluten-free diet, Dapsone

Question 10

Dyshidrotic dermatitis; Allergic contact dermatitis

Answer 10

Hypersensitivity Blistering

Question 11

Type 4 hypersensitivity is mediated by what cell?

Answer 11

Th1

Question 12

Pruritic 1mm tiny vesicles; palms > soles and sides of the digits; Chronic and recurrent condition, intense spongiosis (causes blister formation)

Answer 12

Dyshidrotic eczema (specific type of atopic dermatitis)

Question 13

TX for Dyshidrotic eczema

Answer 13

• Same as atopic dermatitis tx.

Topical steroids, calcineurin inhibitors; occasionally oral steroid if really terrible

Question 14

Very itchy, red-pink edematous papules and vesicles; linear (poison ivy) or geometric shapes to the rash; Delayed-type hypersensitivity (4)

Answer 14

Allergic contact dermatitis

Question 15

The most common cause of allergic contact dermatitis is

Answer 15

Nickel

• then fragrances, neomycin, poison ivy

Question 16

TX for Acute allergic contact dermatitis

Answer 16

Topical steroid or prednisone depending on the severity