Bullous Dermatoses and Drug Eruptions

Question 1

Bullous pemphigoid definition

Answer 1

Autoimmune disorder with autoantibodies against hemidesmosomes (BP230 and BP150)

Question 2

Bullous pemphigoid symptoms

Answer 2

Acute pruritic tense bullae filled with clear fluid on normal to erythematous skin, bullae do not rupture and heal without scarring

Question 3

Bullous pemphigoid locations

Answer 3

Inner thigh, flexor forearms, axilla, groin, lower abdomen

Question 4

Bullous pemphigoid histology

Answer 4

Subepidermal blister with eosinophils

Question 5

Pemphigus vulgaris definition

Answer 5

Secondary to autoantibodies to components of desmosomes (desmogleins 1 and 3)

Question 6

Pemphigus vulgaris symptoms

Answer 6

Flaccid bullae with erosion, oral involvement positive Nikolsky’s sign (red skin, fluid collects underneath, skin rubs off, leaves raw red base)

Question 7

Pemphigus vulgaris histology

Answer 7

Basal cells not attached to each other but still to dermis (tombstone appearance), suprabasal (intraepidermal) blister

Question 8

Pemphigus vulgaris vs bullous pemphigoid age affected

Answer 8

P. vulgaris - younger, B. pemphigoid - elderly

Question 9

Pemphigus vulgaris vs bullous pemphigoid oral involvement

Answer 9

P. vulgaris - yes, B. pemphigoid - no

Question 10

Pemphigus vulgaris vs bullous pemphigoid antibodies

Answer 10

P. vulgaris - against desmoglein 3 (desmosomes), B. pemphigoid - hemidesmosomes

Question 11

Pemphigus vulgaris vs bullous pemphigoid blister characteristics

Answer 11

P. vulgaris - intraepidermal (superficial), flaccid, rupture easily, B. pemphigoid - subepidermal (deep), tense and firm

Question 12

Pemphigus vulgaris vs bullous pemphigoid Nikolsky’s sign

Answer 12

P. vulgaris - positive, B. pemphigoid - negative

Question 13

Pemphigus vulgaris vs bullous pemphigoid immunofluorescence

Answer 13

P. vulgaris - net like IgG, B. pemphigoid - linear IgG

Question 14

Pemphigus vulgaris vs bullous pemphigoid prognosis

Answer 14

P. vulgaris - pt dies without treatment, B. pemphigoid - most pts do well

Question 15

Pemphigus vulgaris vs bullous pemphigoid histology

Answer 15

P. vulgaris - tombstone appearance, B. pemphigoid - eosinophilic infiltrations

Question 16

Urticarial eruptions definition

Answer 16

“Hives”, pruritic eruption, transient, following drug exposure

Question 17

Urticarial eruptions possible associated symptoms

Answer 17

Angioedema, respiratory symptoms, anaphylaxis

Question 18

Urticarial eruptions histology

Answer 18

Superficial dermal edema, dilated blood vessels with perivascular inflammatory cells, normal epidermis

Question 19

Morbilliform eruptions definition

Answer 19

Truly maculopapular, monomorphic, measles-like eruptions following drug exposure

Question 20

Urticarial eruptions timing

Answer 20

7-10 days after drug exposure, earlier if repeat exposure

Question 21

Morbilliform eruptions associated symptoms

Answer 21

Systemic symptoms, fever, malaise

Question 22

Morbilliform eruptions timing

Answer 22

7-10 days after drug exposure (typically antibiotics)

Question 23

Morbilliform eruptions histology

Answer 23

Indistinguishable from a viral exanthema

Question 24

Erythema multiforme definition

Answer 24

Self-limited hypersensitivity usually induced by HSV1

Question 25

Erythema multiforme symptoms

Answer 25

Mouth swelling, painful sores, targetoid, circinate bullae on palms

Question 26

Erythema multiforme age

Answer 26

Kids and young adults

Question 27

Erythema multiforme associated symptoms

Answer 27

Rare systemic symptoms, common oral lesions

Question 28

Erythema multiforme histology

Answer 28

Light lichenoid infiltrate, apoptosis keratinocyte (Colloid body), extensive vacuolar damage at the basement membrane

Question 29

Urticaria vs erythema multiforme central zones

Answer 29

Urticaria - normal skin, EM - damaged skin (dusky, bullous or crusted)

Question 30

Urticaria vs erythema multiforme lesion duration

Answer 30

Urticaria - transiet, lasting several hours, EM - fixed for at least 7 days

Question 31

Urticaria vs erythema multiforme lesion appearance

Answer 31

Urticaria - new lesions appear daily, EM - all lesions appear in first 72 hours

Question 32

Urticaria vs erythema multiforme edema

Answer 32

Urticaria - swelling of hands and feet (angioedema), EM - no edema

Question 33

Stevens-Johnson syndrome/toxic epidermal necrosis definition

Answer 33

Hypersensitivity disorder secondary to viral illness, Mycoplasma, medication, or other

Question 34

Stevens-Johnson syndrome/toxic epidermal necrosis associated symptoms

Answer 34

Fever, systemic symptoms, mucosal erosions, epidermal detachment

Question 35

Stevens-Johnson syndrome/toxic epidermal necrosis difference

Answer 35

Erosions + epidermal detachment <10% SJS, 10-30% overlap, >30% TEN, SJS more common in kids than TEN

Question 36

Stevens-Johnson syndrome/toxic epidermal necrosis presenting signs

Answer 36

Fever, malaise, mucosal pain/swelling, photophobia, erythematous macular eruption

Question 37

Stevens-Johnson syndrome/toxic epidermal necrosis common meds

Answer 37

Anti-epileptics, sulfonamides, PCNs, allopurinol, NSAIDs

Question 38

Stevens-Johnson syndrome/toxic epidermal necrosis management

Answer 38

Rapidly evolves (mortality is almost 30%), needs monitoring in ICU, ophthalmic evaluation, fluid management, dressings, pain control

Question 39

Stevens-Johnson syndrome/toxic epidermal necrosis treatment

Answer 39

IVIG, cyclosporine, steroids, TNF-alpha inhibitors