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Dermatology > Blisters > Flashcards

Blisters Flashcards

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Dermatology Board Prep 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

A

kids

25
Q

Etiology of bullous impetigo

A

exotoxin from bacterium

26
Q

Clinical presentation & diagnosis of bullous impetigo

A

lesions of crusted papules and erosions

culture

27
Q

What is Staphylococcal Scalded Skin Syndrome?

A

generalized form of exotoxin-mediated disease

28
Q

Pathophysiology of Staph Scalded Skin Syndrome?

A

toxin is secreted into blood → widespread superficial blisters

29
Q

Clinical presentation of Staph Scalded Skin Syndrome

A

skin peels away in bed sheets

wound culture from erosions = negative

30
Q

Epidemiology of Staph Scalded Skin Syndrome

A

kids under 2yo

adults w/ renal disease

31
Q

Special consideration with Staph Scalded Skin Syndrome

A

localized vs. extensive blistering

extensive = Derm referral

32
Q

What do vesicles localized on the mouth/nose/eyes indicate?

A

HSV, bullous impetigo

33
Q

What do vesicles localized on the chest/back dermatomally indicate?

A

VZV shingles

34
Q

What do vesicles localized on the fingers indicate?

A

herpetic whitlow, blistering dactylitis, dyshidrotic eczema, contact dermatitis

35
Q

What do vesicles localized on the genitalia/bathing suit distribution indicate?

A

HSV

36
Q

What do vesicles localized on the feet indicate?

A

dyshidrotic eczema, tinea pedis, allergic contact dermatitis

37
Q

What does pain preceding the onset of blister indicate?

A

HSV, VZV

38
Q

What does itch preceding the onset of blister indicate?

A

allergic contact dermatitis, dyshidrotic eczema, VZV

39
Q

What does trauma preceding the onset of blister indicate?

A

friction blister, pressure ulcer, cryotherapy

40
Q

What do recurrent blisters indicate?

A

HSV

41
Q

What is chicken pox?

A

primary varicella zoster virus (VZV) infection

42
Q

Clinical presentation of chicken pox

A

Diffuse scattered vesicles on erythematous base; can be extensive and severe

43
Q

Etiology of pemphigus vulgaris

A

autoimmune

44
Q

Pathophysiology of Pemphigus Vulagris

A

auto-antibodies attack desmogleins

45
Q

Clinical presentation of pemphigus vulgaris

A

superficial bullae and erosions

Nikolsky sign (+)

46
Q

Epidemiology of pemphigus vulgaris and bullous pemphigoid

A

adults

47
Q

Diagnostic testing for pemphigus vulagris

A

DIF = direct immunofluorescence

48
Q

Treatment for Pemphigus Vulgaris and Bullous Pemphigoid

A

burn center; high dose topical steroids (clobetasol, prednisone)

Derm consult

49
Q

What is another name for Bullous Pemphigoid

A

Linear IgA

50
Q

Etiology of Bullous Pemphigoid

A

autoimmune

51
Q

Pathophysiology for Bullous Pemphigoid

A

autoantibodies attack hemidesmosome

52
Q

Histology differences between Bullous Pemphigoid and Pemphigus Vulgaris

A

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
Q

Clinical presentation for Bullous Pemphigoid

A

deep, tense bullae

Nikolsky (-)

Dermatology (5 decks)

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