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Dermatology - Clinical Medicine IV > Bullous Diseases > Flashcards

Bullous Diseases Flashcards

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Dermatology Board Prep flashcards
1
Q

Autoimmune, blistering skin disease

IgG mediated

A

bullous pemphigoid

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2
Q

What happens in bullous pemphigoid?

A

Autoantibodies bind to skin basement membrane

Creates inflammatory reactions that creates blisters

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3
Q

What is the epi of bullous pemphigoid?

A

uncommon, 5th-7th decage = avg age 65

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4
Q

What are the triggers of bullous pemphigoid?

A

UV irradiation
Xray therapy
Drugs- furosemide, ibuprofen, captopril, antibiotics (penicillamine

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5
Q

What is the clinical presenation of bullous pemphigoid?

A

Widespread, tense blisters

Associated with prodromal eruption

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6
Q

What are some common sites of bullous pemphigoid?

A

Axillae, medial thighs, groin, abdomen, forearms- flexor surfaces
Lower legs- often first site
Mucous Membranes- rare

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7
Q

What PE do you do for bullous pemphigoid?

A

Preceding lesion
Weeks to months prior
Various sizes
Serous or hemorrhagic fluid

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8
Q

What is the workup for bullous pemphigoid?

A

biopsy with DIF studies, ELISA

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9
Q

What is the treatment for bullous pemphigoid?

A 
Glucocorticoids
Prednisone
Immunosuppressants
Azathioprine (Imuran)
Biologics
Rituximab (Rituxan)
Treat secondary infection
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10
Q

What is the prognosis of bullous pemphigoid?

A

long term remssion after tx

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11
Q

What is pemphigus?

A

Autoimmune
IgG bind to desmogleins (cell to cell adhesions)
Keratinocytes can’t bind leading to split in epidermis/mucosal epithelium

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12
Q

What are the two types of pemphigus?

A

vulgaris

foliaceus

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13
Q

What is PV?

A

serous fliud filled vesicles and bulla affecting oral mucosa

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14
Q

How does PV present?

A

painful

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15
Q

What is the sign for PV?

A

Nikolsky sign

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16
Q

What are the sites you get PV?

A

scalp, face, chest, axillae, groin, umbilicus

17
Q

What is vegetative pemphigus vulgaris?

A

PV lesions from vegetating granulations

18
Q

What is PF?

A

Bullae transform to scaly, crusted erosions
No mucosal lesions
Erythematosus base

19
Q

What are common sites for PF?

A

face, scalp, upper trunk

20
Q

What are teh variations of pemphigus foliaceus?

A 
Pemphigus erythematosus
Pemphigus herpetiformis
Endemic pemphigus foliaceus
IgA pemphigus foliaceus
Drug induced pemphigus foliaceus
21
Q

What is the work up for pemphigus?

A

Direct immunofluorescence (DIF)- autoantibodies
Indirect immunofluorescence
ELISA

22
Q

What is the treatment for pemphigus?

A 
Need to be aggressive
Glucocorticoids
Prednisone 2-3 mg/kg daily until new blister formation stops
Immunosuppressive therapy
Methotrexate, Rituximab
Antibiotics- if indicated
Wound care
Cleansing baths; dressing changes; Fluid/electrolyte balance
23
Q

What is dermatitis herpetiformis?

A

Autoimmune- IgA deposits in dermis

Associated with gluten-sensitive enteropathy

24
Q

What do the lesions in dermatitis herpetiformis?

A 
Grouped erythematous papules or wheals
Topped with vesicles
Excoriation and crusts
Extremely pruritic
Burning, stinging, itching before lesions appear
25
Q

What is the epi of dermatitis herpetiformis?

A

11/100K, men more, 2-4th decade

26
Q

What is the work up for DH?

A

skin biopsy

27
Q

What is the treatment for DH?

A

Avoid gluten
Diaminodiphenyl (Dapsone)
sulfapyridine

Dermatology - Clinical Medicine IV (31 decks)

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