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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
What is acantholysis
Loss of intercellular adhesion sites
26
Symptoms of Pemphigus vulgaris
Fluid filled, painful, fragile blisters Rupture to form shallow eruptions
27
Where do Pemphigus vulgaris usually present
Skin: scalp, face, axillae, groin, trunk Mucosa: mouth, resp tract
28
Will Pemphigus vulgaris be nikolsky sign positive
YES
29
Immunofluorescence of Pemphigus vulgaris
Chicken wire deposition of IgG within the epidermis
30
Local disease management of Pemphigus vulgaris
Topical steroids + anaesthetics
31
Systemic management of Pemphigus vulgaris
Prednisolone + azathioprine
32
What is dermatitis herpetiformis associated with
Coeliac disease
33
When does dermatitis herpetiformis usually present
15-40 years
34
What gene is dermatitis herpetiformis associated with
HLA-DQ2 halotype
35
Pathophysiology of dermatitis herpetiformis
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
Clinical presentation of dermatitis herpetiformis
Intensely itchy symmetrical lesions on an erythematous and swollen base
37
Where can dermatitis herpetiformis present
Extensor aspect of elbows and forearms Buttocks and scapulae Extensor aspects of knees Face and scalp
38
Blood results for a patient with dermatitis herpetiformis
Anti-TTG
39
Immunofluorescence of dermatitis herpetiformis
Granular deposits of IgA in dermal papillae
40
Histology of dermatitis herpetiformis
Subepidermal blisters with papillary dermal micro-abscesses
41
Management of dermatitis herpetiformis
Gluten free diet +/- dapsone Topical steroids for symptoms
42
Complication of dermatitis herpetiformis
Rare but significantly increased risk of small bowel lymphoma

dermatology (13 decks)

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