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UCD Dermatology - Term 2 > Blistering Eruptions > Flashcards

Blistering Eruptions Flashcards

1
Q

List 5 common causes of blistering

List 5 less common causes of blistering

A
  • Infection
  • Edema
  • Bites (insect/spider)
  • Trauma
  • Drugs
  • Genetic
    • Epidermolysis bullosa
  • Metabolic
    • Porphyrias
  • Immunobullous
    • Bullous pemphigoid
    • Pemphigus vulgaris
    • Dermatitis herpetiformis
    • Linear IgA disease
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2
Q

Name this dermatological disorder

What is the recommended management?

A

Bullous impetigo

  • Wash affected skin daily (chlorhexidine, sodium hypochlorite/povidone-iodine)
  • Topical antibiotics BID x 5-7/7
    • Mupirocin, fucidic acid, 2% clindamycin cream
  • If widespread blisters/lymphadenopathy
    • 1st line: PO Abx (cephalexin, clavulin, cloxacillin, clindamycin)
    • 2nd line: macrolides
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3
Q

Name this dermatological disorder

A

Varicella

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4
Q

Name this dermatological disorder

A

Edema bullae

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5
Q

Name this dermatological disorder

A

Diabetic blistering

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6
Q

Name this dermatological disorder

A

SJS/TEN

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7
Q

List 3 immunobullous disorders that occur subepidermal and 2 clinical features associated with these

List the immunobullous disorder that occurs intraepidermal and 2 clinical features associated with this

A

Subepidermal

  • Bullous pemphigoid
  • Dermatitis herpetiformis
  • Linear IgA disease

Clinical Features

  • Tense bilsters
  • Nikolsky sign is negative

Intraepidermal

  • Pemphigus vulgaris
  • Clinical Features*
  • Flaccid blisters
  • Erosions
  • Nikolsky sign is positive
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8
Q

What is the antibody-mediated immune response target in bullous pemphigoid?

What antigens are involved?

What ends up happening?

A

Structural proteins (hemidesmosomes) at the dermoepidermal junction (basement membrane)

BPAg1 (BP230) , BPAg2 (BP180)

Epidermis is no longer stuck to dermis, so it lifts up and causes blister formation

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9
Q

What is the antibody-mediated immune response target in dermatitis herpetiformis?

A

Epidermal tissue transglutaminase

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10
Q

What is the antibody-mediated immune response target in pemphigus vulgaris?

What happens when these are attacked?

Which target is most commonly affected for cutaneous erosions?

Which target is most commonly affected for mucosal erosions?

A

Desmoglein (DSG) 1 and 3

Causes loss of cell adherence between keratinocytes, called acantholysis

Cutaneous = DSG 1 >3

Mucosal = DSG 3 > 1

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11
Q

What is associated with bullous pemphigoid?

What age group is bullous pemphigoid typically seen with?

What would be the suspected etiology of bullous pemphigoid if present in a 20 year old?

A

Neurological disease

>75 years

Drug-induced

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12
Q

What drugs are associated with bullous pemphigoid? List 5

A
  • Analgesics
  • Antibiotics, including penicillins
  • Captopril
  • Diuretics (furosemide, spironolactone)
  • Sulfasalazine
  • PD1-inhibitor immunotherapies (melanoma treatment)
  • Antidiabetic drugs - the gliptins
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13
Q

What immunobullous disorder has this DIF?

A

Bullous pemphigoid

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14
Q

If bullous pemphigoid is seen in pregnancy, what is it called?

What are the autoantibodies against?

A

Pemphigoid Gestationis

BP180

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15
Q

What malignancy is associated with dermatitis herpetiformis?

A

Small bowel lymphoma

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16
Q

Name this dermatological disorder

A

Dermatitis herpetiformis

17
Q

What immunobullous disorder has this DIF?

What’s the mechanism?

A

Dermatitis herpetiformis

Deposition of IgA anti-transglutaminase autoantibodies in the dermal papillae

18
Q

Name this dermatological disorder

How would you describe the borders?

What age group is this most commonly seen in?

How is it typically managed?

A

Linear IgA disease

“String of pearls”

Children

Dapsone

19
Q

Name this dermatological disorder

A

Pemphigus foliaceus

(cutaneous pemphigus = affects DSG 1>3)

20
Q

What immunobullous disorder has this DIF?

A

Pemphigus vulgaris

21
Q

What is the recommended management of immunobullous disorders?

A

FIRST LINE

  • Topical corticosteroids (like dermovate - ultra high potency) +/- systemic corticosteroids
  • Steroid-sparing immunosuppressants (AZA, MMF) +/- immunomodulating agents (dapsone, tetracyclines)

SEVERE

  • Anti-B cell - rituximab
  • IVIG
22
Q

What is the most likely diagnosis with this presentation?

What associated disorders are found with this diagnosis?

A

Porphyria cutanea tarda

  • Liver disease
  • Hemochromatosis
  • Hepatitis C
23
Q

How do you send biopsies for a suspected immunobullous disorder

A

Edge of blister for H&E

Normal, non-inflamed skin for DIF

UCD Dermatology - Term 2 (14 decks)

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