Bullous skin disease

Question 1

Aetiology of bullous pemphigoid

Answer 1

IgG Abs bind to hemidesmosomes of basement membrane → subepidermal bulla
Eosinophils release elastase- damaging anchoring proteins
PemphigoiD - Bullae are Deep

Question 2

Clinical features of bullous pemphigoid

Answer 2

Large tense bullae, erythematous base. Precipitated by PD1-inhibitor & DPP4-inhibitors e.g. sitagliptin

Question 3

Management for bullous pemphigoid

Answer 3

Localised: consider topical steroids/tacrolimus

Widespread:
PO prednisolone 0.5-2mg/kg/day
± sedating antihistamines e.g. hydroxyzine

Question 4

Aetiology of pemphigus vulgaris

Answer 4

IgG Abs bind to desmosome proteins 1,3 à
intraepidermal bulla
T2 hypersensitivity reaction
PemphiguS - Bullae are
Superficial

Question 5

Clinical features of pemphigus vulgaris

Answer 5

Easily rupture (red, raw) flaccid blisters
Skin AND mucosal membranes

Question 6

Management for pemphigus vulgaris

Answer 6

PO prednisolone AND azathioprine PO/MMF
OR rituximab

Question 7

Aetiology of pemphigus foliaceus

Answer 7

IgG Ab against desmoglein 1 attacks outer layer of keratinocytes where stratum corneum is found

Question 8

Clinical features of pemphigus foliaceus

Answer 8

Very rare
No intact bullae
Appears excoriated

Question 9

Management for pemphigus foliaceus

Answer 9

Topical steroid e.g. betamethasone