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Blisters Flashcards

1
Q

What is the difference between a vesicle and a bulla?

A

vesicle = small ( <1cm)
bulla = larger (>1cm)

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2
Q

What are the 4 causes of blisters?

A
  • inflammation/infection
  • injury
  • autoimmune
  • genetic
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3
Q

How can inflammation/infection cause blisters?

A

fluid build-up w/in epidermis causing it to lift

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4
Q

How can injury cause blisters?

A

physical disruption of bonds btwn epidermal cells or at dermoepidermal junction

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5
Q

How can an autoimmune disorder cause blisters?

A

loss/disruption of adhesion molecules between cells or at dermoepidermal junction

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6
Q

How can genetics cause blisters?

A

change/loss of proteins that contribute to cellular adhesion

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7
Q

What forms when the top of a blister is disrupted?

A
  • erosion = loss of partial/full epidermis
  • ulceration = loss of epidermis and partial dermis; oozes serous fluid = crust
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8
Q

What are important information to obtain when evaluating blisters?

A
  • symptoms
  • triggers
  • timing (inital or recurrent)
  • distribution
  • location
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9
Q

Etiology of Shingles

A

reactivation of VZV (varicella)

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10
Q

Epidemiology of shingles

A

adults (19yo+)

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11
Q

Clinical presentation of Shingles

A
  • unilateral dermatomal eruption
  • grouped vesicles on erythematous base
  • pain/burning sensation before eruption
  • common on trunk but can be anywhere
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12
Q

Clinical presentation of HSV

A

painful, grouped vesicles on erythematous base

vesicles can be pustular ; rarely see them tho; mostly see erosions

recurs on same place

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13
Q

What is the difference between HSV-1 and HSV-2?

A

HSV-1 = mouth and nose (above waist)
HSV-2 = below belt

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14
Q

Key presentation of HSV

A

erosion w/ bright erythematous base

pain and recurrence

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15
Q

Where do recurrent HSV infections typically show up?

A

genitals, butt, thighs

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16
Q

DDx for HSV infections

A

single genital ulcers = can indicate syphilis or chancroid = look for recurrence

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17
Q

Diagnostic testing for HSV

A
  • Tzanck prep
  • Viral culture
  • PCR
  • DFA (direct fluorescent Ab test) = best = differentiate between herpes viruses
  • blood test for IgG
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18
Q

Treatment for HSV

A

Acyclovir = safe and cheap, IV available - 800mg TID 2 days

  • cool compress
  • lubricants
  • topical/oral anaglesics
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19
Q

How is neonatal HSV acquired?

A

in utero; perinatally; or postnatally

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20
Q

3 classifications for neonatal HSV

A
  • Localized = SEM (skin, eye, mouth)
  • CNS w/ or w/o SEM
  • Disseminated involving multiple organs
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21
Q

Prognosis of neonatal HSV

A

early diagnosis = critical

untreated = high neonate mortality rate

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22
Q

Blisters on finger = Herpetic whitlow vs. Blistering dactylitis

A

herpetic whitlow = multiple, red borders, presence of oral HSV

blistering dactylitis = single bulla by Strep

culture vesicle

23
Q

What is impetigo?

A

infection by Gram(+) bacteria; S. aureus

24
Q

Epidemiology of bullous impetigo

25
Etiology of bullous impetigo
exotoxin from bacterium
26
Clinical presentation & diagnosis of bullous impetigo
lesions of crusted papules and erosions culture
27
What is Staphylococcal Scalded Skin Syndrome?
generalized form of exotoxin-mediated disease
28
Pathophysiology of Staph Scalded Skin Syndrome?
toxin is secreted into blood → widespread superficial blisters
29
Clinical presentation of Staph Scalded Skin Syndrome
skin peels away in bed sheets wound culture from erosions = negative
30
Epidemiology of Staph Scalded Skin Syndrome
kids under 2yo adults w/ renal disease
31
Special consideration with Staph Scalded Skin Syndrome
localized vs. extensive blistering extensive = Derm referral
32
What do vesicles localized on the mouth/nose/eyes indicate?
HSV, bullous impetigo
33
What do vesicles localized on the chest/back dermatomally indicate?
VZV shingles
34
What do vesicles localized on the fingers indicate?
herpetic whitlow, blistering dactylitis, dyshidrotic eczema, contact dermatitis
35
What do vesicles localized on the genitalia/bathing suit distribution indicate?
HSV
36
What do vesicles localized on the feet indicate?
dyshidrotic eczema, tinea pedis, allergic contact dermatitis
37
What does pain preceding the onset of blister indicate?
HSV, VZV
38
What does itch preceding the onset of blister indicate?
allergic contact dermatitis, dyshidrotic eczema, VZV
39
What does trauma preceding the onset of blister indicate?
friction blister, pressure ulcer, cryotherapy
40
What do recurrent blisters indicate?
HSV
41
What is chicken pox?
primary varicella zoster virus (VZV) infection
42
Clinical presentation of chicken pox
Diffuse scattered vesicles on erythematous base; can be extensive and severe
43
Etiology of pemphigus vulgaris
autoimmune
44
Pathophysiology of Pemphigus Vulagris
auto-antibodies attack desmogleins
45
Clinical presentation of pemphigus vulgaris
superficial bullae and erosions Nikolsky sign (+)
46
Epidemiology of pemphigus vulgaris and bullous pemphigoid
adults
47
Diagnostic testing for pemphigus vulagris
DIF = direct immunofluorescence
48
Treatment for Pemphigus Vulgaris and Bullous Pemphigoid
burn center; high dose topical steroids (clobetasol, prednisone) Derm consult
49
What is another name for Bullous Pemphigoid
Linear IgA
50
Etiology of Bullous Pemphigoid
autoimmune
51
Pathophysiology for Bullous Pemphigoid
autoantibodies attack hemidesmosome
52
Histology differences between Bullous Pemphigoid and Pemphigus Vulgaris
Bullous Pemphigoid = subpidermal vesicle formation; DIF shows linear IgG and C3 along dermoepidermal junction Pemphigus Vulgaris = - acantholysis = loss of intercellular connections between keratinocytes = row of tombstones; DIF shows IgG in reticular pattern
53
Clinical presentation for Bullous Pemphigoid
**deep, tense** bullae Nikolsky (-)

Dermatology (5 decks)

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