Blistering/Papular diseases Flashcards
PEMPHIGUS VULGARIS
PEMPHIGUS VULGARIS
PEMPHIGUS VULGARIS
PEMPHIGUS VULGARIS
general
▸ Life-threatening, chronic autoimmune blistering disorder of the mucus membranes and skin
▸ Most common in patients in their 30s and 40s
▸ Associated with several medications – penicillamine, captopril, cephalosporins, phenobarbital
(PPCC)
PEMPHIGUS VULGARIS
pathophys
Type of sensitivity
▸ Type II hypersensitivity reaction where autoantibodies against desmoglein lead to
acantholysis
▸ Desmoglein connects keratinocytes in the skin
PEMPHIGUS VULGARIS
Clin man
▸ Painful erosion or ulceration initially, followed by painful, flaccid skin bola that rupture easily, leaving painful
denuded skin erosions that bleed easily.
▸ Initial lesion is most commonly intraoral
▸ Positive Nikolsky sign – detachment of skin under pressure/trauma
PEMPHIGUS VULGARIS
Dx and Tx
Diagnosis: punch biopsy – IgG throughout the epidermis, basal keratinocytes in a pattern that resembles “a row of
tombstones”
▸ ELISA - anti-desmoglein or anti-epithelial autoantibodies
▸ Treatment: refer to dermatology
▸ Mainstay of treatment: Systemic glucocorticoids + wound care +/-rituximab, mycophenolate or azathioprine
BULLOUS PEMPHIGOID
BULLOUS PEMPHIGOID
BULLOUS PEMPHIGOID
general
Induced by
▸ Autoimmune disorder leading to blister formation
and severe itching
▸ Primarily seen in the elderly
▸ Can be drug induced – loop diuretics, metformin
bullous pemphigoid
pathophys and type of sensitivity
Type II hypersensitivity reaction – IgG
autoantibodies against hemidesmosomes and
basement membrane zone causing subepidermal
blistering
BULLOUS PEMPHIGOID
Clin man
▸ Prodrome of pruritus with eczematous or urticarial erythematous plaques followed by multiple tense large bullae that easily rupture
▸ Most commonly found in the groin, axilla, trunk, flexural areas of the extremities
▸ Mucosal disease in 10-30%
▸ Negative Nikolsky sign
bullous pemphigoid
Dx and Tx
Mild/localized and severe
Diagnosis: punch biopsy with direct immunofluorescence - linear C3, IgG along the dermal-epidermal junction, subepidermal blistering,
eosinophilia
▸ ELISA: autoantibodies against BP antigen 230 & 180
Treatment: refer to dermatology
▸ Localized/Mild - High potency topical corticosteroids + tetracyclines (doxycycline)
▸ Extensive/Severe - systemic corticosteroid
PORPHYRIA CUTANEA TARDA
PORPHYRIA CUTANEA TARDA
general
Hypersensitivity of the skin to abnormal porphyrins when exposed to light, leading to a blistering disease of sun exposed areas
▸ Enzyme: uroporphyrinogen decarboxylase
PORPHYRIA CUTANEA TARDA
risk factors
Liver disease – hepatitis C, alcoholism, hemachromatosis
▸ Estrogen use, Tobacco use
PORPHYRIA CUTANEA TARDA
cliln man
Chronic blistering photosensitivity of sun exposed areas – can lead to hyper- or hypopigmentation/scarring
PORPHYRIA CUTANEA TARDA
Dx and Tx
Diagnosis: 24 hour urine collection, plasma porphyrin profile
▸ Treatment: treat the underlying cause
▸ phlebotomy, low-dose hydroxychloroquine, sun avoidance
verruca vulgaris
verruca vulgaris
VERRUCA VULGARIS
general and types
Caused by human papilloma and virus
▸ HPV infects keratinized skin causing excessive proliferation and retention of the stratum corneum
▸ Types:
▸ Common: vulgaris - common on hands
▸ Plantar: plantaris
▸ Flat: plana - commonly found on face, hands, knees, and shin
VERRUCA VULGARIS
clin man
firm, hyperkeratotic papules between 1-10 mm with red/brown punctations (thrombosed capillaries are
pathognomonic)
VERRUCA VULGARIS
Dx and Tx
▸ Diagnosis: clinical
▸ DO NOT BIOPSY!
▸ Treatment:
▸ If immunocompetent most warts resolve within 2 years
▸ Topical: OTC salicylic acid - I recommend WartStick because it’s 40% sal acid
▸ Cryotherapy and imiquimod are also commonly used in practice
CONDYLOMA ACCUMINATA
Caused by and can progress into
▸ Caused by Human papillomavirus infection
▸ If left untreated, these lesions can progress to squamous cell
carcinoma
CONDYLOMA ACCUMINATA
CONDYLOMA ACCUMINATA
Clin Man
▸ Vary from small, flat topped painless raised papules, which
can evolve into large, soft, flashy, cauliflower like lesions and
clusters on the anogenital mucosa and surrounding skin
▸ Ranging from skin colored to pink/red
▸ Lesions persist for months and May spontaneously resolve,
remain unchanged, or grow if untreated
CONDYLOMA ACUMINATA
Dx and Tx
Diagnosis: clinical
▸ Biopsy is rarely needed – acanthosis with overlying hyperplastic hyperkeratosis koilicytotic squamous
cells and atypical keratinocytes with papillomatosis hyperplasia
▸ Treatment:
▸ 80% with HPV six, 11 will have spontaneous resolution within 18 months
▸ First line: antiproliferative agents – imiquimod, immunomodulators - podophyllotoxin, sinecatechins
▸ First line clinician administered treatments: cryotherapy, trichloracetic acid, surgical remova
CONDYLOMA ACUMINATA
prevention
Gardasil 9 vaccination
MOLLUSCUM CONTAGIOSUM
MOLLUSCUM CONTAGIOSUM
general
Benign, often asymptomatic, viral infection of the skin
without systemic manifestations
▸ Poxviridae
▸ Most commonly seen in young, school-age children
MOLLUSCUM CONTAGIOSUM
clin man
Hallmark
▸ Characterized by small, skin color to pink, dome shaped
papules with central umbilication
▸ Lesions can develop anywhere in the body but are most
commonly seen in areas of high friction
▸ Lesions can last for months to years
MOLLUSCUM CONTAGIOSUM
Dx and Tx
Diagnosis: clinical
Treatment:
▸ Asymptomatic: observance
▸ First-line treatment: curettage
▸ Cryotherapy, imiquimod, topical retinoids are most commonly used in
practice
