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dermatology > Blistering Skin Conditions > Flashcards

Blistering Skin Conditions Flashcards

1
Q

Clinical features of an intra-epidermal blister

A

Thin roof so burst easily

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2
Q

Name of an intra-epidermal blister

A

Pemphigus

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3
Q

Name of a sub-epidermal blister

A

Pemphigoid

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4
Q

Clinical feature of a sub-epidermal blister

A

Thick roof so more likely to stay intact

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5
Q

What is a bullous pemphigoid

A

Subepidermal blister caused by an autoimmune reaction

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6
Q

When does bullous pemohigoid usually present

A

> 60

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7
Q

Associations with bullous pemphigoid

A

Neurological disease: stroke, dementia, Parkinson’s
Internal malignancy
Autoimmune diseases

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8
Q

Name some drugs that can cause bullous pemphigoid

A

Diuretics
Analgesics
Antibiotics
Potassium iodide
Good
Captopril

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9
Q

Pathophysiology of bullous pemphigoid

A

IgG reacts with the major or minor antigen of the hemidesmosomes anchoring basal cells to the basement membrane
Compliment activation causes interruption of the DEJ and the formation of a subepidermal blister

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10
Q

What kind of hypersensitivity reaction is bullous pemphigoid

A

Type 2

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11
Q

Symptoms of bullous pemphigoid

A

Pruritus
Well demarcated erythematous plaques before the blisters
Large tense extremely itchy blisters

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12
Q

Nikolskys sign

A

Lateral pressure on the skin next to the blister causes it to extend

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13
Q

Will bullous pemphigoid be nikolsky sign positive

A

NO - negative

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14
Q

Histology of bullous pemphigoid

A

Subepidermal blisters with inflammatory infiltrates

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15
Q

Immunofluorescence on bullous pemphigoid

A

IgG and complement deposited around the basal membrane

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16
Q

Local management of bullous pemphigoid

A

Prednisolone

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17
Q

Systemic management of bullous pemphigoid

A

Prednisolone
+/- tetracycline antibiotics
+/- antihistamine

18
Q

Why do we use antihistamines for bullous pemphigoid

A

For sedating and anti-pruritic properties

19
Q

Why do we use tetracyclines for bullous pemphigoid

A

As steroid sparing agents

20
Q

What do we do if we get no response to treatment for bullous pemphigoid

A

Immunosuppression with azathioprine or methotrexate

21
Q

What is the most common subtype of pemphigus

A

Pemphigus vulgaris

22
Q

When does Pemphigus vulgaris usually present

A

Middle age 40-60

23
Q

What kind of hypersensitivity reaction is Pemphigus vulgaris

24
Q

Pathophysiology of Pemphigus vulgaris

A

IgG antibodies against desmosomal proteins lead to loss of keratinocyte adhesion in the skin and mucous membranes

25
Q

What is acantholysis

A

Loss of intercellular adhesion sites

26
Q

Symptoms of Pemphigus vulgaris

A

Fluid filled, painful, fragile blisters
Rupture to form shallow eruptions

27
Q

Where do Pemphigus vulgaris usually present

A

Skin: scalp, face, axillae, groin, trunk
Mucosa: mouth, resp tract

28
Q

Will Pemphigus vulgaris be nikolsky sign positive

29
Q

Immunofluorescence of Pemphigus vulgaris

A

Chicken wire deposition of IgG within the epidermis

30
Q

Local disease management of Pemphigus vulgaris

A

Topical steroids + anaesthetics

31
Q

Systemic management of Pemphigus vulgaris

A

Prednisolone + azathioprine

32
Q

What is dermatitis herpetiformis associated with

A

Coeliac disease

33
Q

When does dermatitis herpetiformis usually present

A

15-40 years

34
Q

What gene is dermatitis herpetiformis associated with

A

HLA-DQ2 halotype

35
Q

Pathophysiology of dermatitis herpetiformis

A

IgA transglutimase antibodies target glial in component of gluten but cross react with connective tissue matrix proteins
Immune complexes form in in dermal papillae
Subepidermal blisters

36
Q

Clinical presentation of dermatitis herpetiformis

A

Intensely itchy symmetrical lesions on an erythematous and swollen base

37
Q

Where can dermatitis herpetiformis present

A

Extensor aspect of elbows and forearms
Buttocks and scapulae
Extensor aspects of knees
Face and scalp

38
Q

Blood results for a patient with dermatitis herpetiformis

39
Q

Immunofluorescence of dermatitis herpetiformis

A

Granular deposits of IgA in dermal papillae

40
Q

Histology of dermatitis herpetiformis

A

Subepidermal blisters with papillary dermal micro-abscesses

41
Q

Management of dermatitis herpetiformis

A

Gluten free diet +/- dapsone
Topical steroids for symptoms

42
Q

Complication of dermatitis herpetiformis

A

Rare but significantly increased risk of small bowel lymphoma

dermatology (13 decks)

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