Bullous Disorders Flashcards
What are the three main bullies disorders?
Bullous pemphigoid
Pemphigus vulgaris
Dermatitis herpetiformis
Which disorder is intra-epidermal and what effect does this have on the clinical presentation?
Pemphigus vulgaris
–> roof of blisters thin so burst and appear as erosions
Which disorder is sub-epidermal and what effect does this have on the clinical presentation?
Bullous pemphigoid (d = deep) --> strong roof blisters, don't burst easily
What is seen on biopsy in bullous pemphigoid?
Entire epidermis lifted
What is the pathology of bullous pemphigoid?
IgG antibodies against hemi-desmosomes holding basal cells to basement membranes
How is bullous pemphigoid diagnosed?
Immunofluorescence –> LINEAR IgG along basement membrane
What is the treatment of bullous pemphigoid?
If localised –> highly potent topical steroids
If generalised –> systemic prednisolone, doxycycline or methotrexate
Where might lesions be seen in pemphigus vulgaris other than the skin?
Vulva, conjunctiva, pharynx, larynx, oesophagus, rectum
What is Nikolsky’s sign and which condition is it +ve in?
If you rub the skin you can induce a blister or increase the size of an already existing blister
–> +ve in pemphigus vulgaris
What is seen on a biopsy in pemphigus vulgaris?
Separation within the epidermis
What is the pathology of pemphigus vulgaris?
IgG antibodies against desmosomes
How is pemphigus vulgaris diagnosed?
Immunofluorescence –> Chicken wire pattern of IgG
Which condition is dermatitis herpetiformis associated with?
Coeliac disease
What are the features of dermatitis herpetiformis?
Itchy lesions precede blisters
Buttocks, lower back, extensors
Small blisters/erosions on erythematous urticarial base
Excoriations
How is dermatitis herpetiformis diagnosed?
Immunofluorescence –> granular deposits of dermal papillary IgA
