Blistering/Papular diseases Flashcards

1
Q
A

PEMPHIGUS VULGARIS

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2
Q
A

PEMPHIGUS VULGARIS

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3
Q
A

PEMPHIGUS VULGARIS

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4
Q

PEMPHIGUS VULGARIS

general

A

▸ 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)

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5
Q

PEMPHIGUS VULGARIS

pathophys
Type of sensitivity

A

Type II hypersensitivity reaction where autoantibodies against desmoglein lead to
acantholysis
▸ Desmoglein connects keratinocytes in the skin

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6
Q

PEMPHIGUS VULGARIS

Clin man

A

▸ 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

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7
Q

PEMPHIGUS VULGARIS

Dx and Tx

A

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

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8
Q
A

BULLOUS PEMPHIGOID

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9
Q
A

BULLOUS PEMPHIGOID

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10
Q

BULLOUS PEMPHIGOID

general
Induced by

A

▸ Autoimmune disorder leading to blister formation
and severe itching
▸ Primarily seen in the elderly
▸ Can be drug induced – loop diuretics, metformin

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11
Q

bullous pemphigoid

pathophys and type of sensitivity

A

Type II hypersensitivity reaction – IgG
autoantibodies against hemidesmosomes and
basement membrane zone causing subepidermal
blistering

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12
Q

BULLOUS PEMPHIGOID

Clin man

A

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

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13
Q

bullous pemphigoid

Dx and Tx
Mild/localized and severe

A

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

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14
Q
A

PORPHYRIA CUTANEA TARDA

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15
Q

PORPHYRIA CUTANEA TARDA

general

A

Hypersensitivity of the skin to abnormal porphyrins when exposed to light, leading to a blistering disease of sun exposed areas
▸ Enzyme: uroporphyrinogen decarboxylase

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16
Q

PORPHYRIA CUTANEA TARDA

risk factors

A

Liver disease – hepatitis C, alcoholism, hemachromatosis
▸ Estrogen use, Tobacco use

17
Q

PORPHYRIA CUTANEA TARDA

cliln man

A

Chronic blistering photosensitivity of sun exposed areas – can lead to hyper- or hypopigmentation/scarring

18
Q

PORPHYRIA CUTANEA TARDA

Dx and Tx

A

Diagnosis: 24 hour urine collection, plasma porphyrin profile

▸ Treatment: treat the underlying cause
▸ phlebotomy, low-dose hydroxychloroquine, sun avoidance

19
Q
A

verruca vulgaris

20
Q
A

verruca vulgaris

21
Q

VERRUCA VULGARIS

general and types

A

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

22
Q

VERRUCA VULGARIS

clin man

A

firm, hyperkeratotic papules between 1-10 mm with red/brown punctations (thrombosed capillaries are
pathognomonic)

23
Q

VERRUCA VULGARIS

Dx and Tx

A

▸ 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

24
Q

CONDYLOMA ACCUMINATA

Caused by and can progress into

A

▸ Caused by Human papillomavirus infection
▸ If left untreated, these lesions can progress to squamous cell
carcinoma

25
CONDYLOMA ACCUMINATA
26
# 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
27
# 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
28
# CONDYLOMA ACUMINATA prevention
Gardasil 9 vaccination
29
MOLLUSCUM CONTAGIOSUM
30
# MOLLUSCUM CONTAGIOSUM general
Benign, often asymptomatic, viral infection of the skin without systemic manifestations ▸ Poxviridae ▸ Most commonly seen in young, school-age children
31
# 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
32
# MOLLUSCUM CONTAGIOSUM Dx and Tx
Diagnosis: clinical Treatment: ▸ Asymptomatic: observance ▸ First-line treatment: **curettage** ▸ Cryotherapy, imiquimod, topical retinoids are most commonly used in practice