Dermatology Flashcards
In Pemphigus Vulgaris, antibodies are produced against antigens in the _______
Intercellular spaces of the epidermal cells
What are the causes of Pemphigus Vulgaris?
- Idiopathic
- ACE inhibitors
- Penicillamine
Nikolsky’s sign is present in the following conditions:
- Pemphigus vulgaris
- Staphylococcal scalded skin syndrome
- Toxic epidermal necrolysis
Lesions of Pemphigus Vulgaris are:
Painful, not pruritic
Treatment for Pemphigus Vulgaris?
- Glucocorticoids (such as prednisone)
- When steroids are ineffective: Azathioprine, Mycophenolate, Cyclophosphamide
Can Pemphigoid be drug induced?
Yes, by sulfa drugs and others
Explain the difference in skin fractures found in Pemphigus Vulgaris and Bullous Pemphigoid
Vulgaris – Acts like a burn, bullae (destruction within epidermis) are relatively thin and fragile.
Pemphigoid – Blisters are relatively deep, bullae are thicker walled. Less likely to rupture
How do you test for Pemphigus Vulgaris?
Biopsy of the skin
How do you test for Bullous Pemphigoid?
Biopsy with immunofluorescent antibodies
Treatment for Bullous Pemphigoid
- Systemic steroids, such as prednisone
- Alternatives to steroids: Tetracycline, Erythromycin w/nicotinamide
Describe the age range, severity, bullae, if the mouth is involved, and other features of Pemphigus Vulgaris
- 30’s and 40’s
- Life threatening
- Thin and fragile
- Yes
- Nikolsky’s sign
Describe the age range, severity, bullae, and other features of Bullous Pemphigoid
- 70’s and 80’s
- Resolves
- Thick and intact
- No
- No other features
Are oral lesions found in Bullous Pemphigoid?
Yes, but rare
Are oral lesions found in Pemphigus Foliaceus?
No
What is Pemphigus Foliaceus?
Blistering disease associated w/other autoimmune diseases OR drug induced by ACE inhibitors or NSAIDS
Describe the bullae in Pemphigus Foliaceus
Much more superficial than B. Pemphigoid and P. Vulgaris
Intact bullae are not seen because they break so easily.
Are oral lesions found in Pemphigus Foliaceus?
No
How is Pemphigus Foliaceus diagnosed and treated?
Same as Pemphigus Vulgaris:
- Biopsy
- Glucocorticoids (such as prednisone)
When steroids are ineffective: Azathioprine, Mycophenolate, Cyclophosphamide
What is Porphyria Cutanea Tarda?
Disorder of porphyrin metabolism –> photosensitivity reaction to abnormally high accumulation of porphyrins
List the conditions that are associated with PCT
- Alcoholism
- Liver disease
- Chronic hepatits C
- Oral contraceptives
- Chronic hepatitis or hemochromatosis PCT, is associated w/increased liver iron stores
- Diabetes (found in 25% of patients)
What is PCT present with?
- Nonhealing blisters on sun-exposed parts of body
- Hyperpigmentation of skin
- Hypertrichosis of face
How do you test for PCT?
Test for urinary uroporphyrins
Uroporphyrins are elevated 2-5 times above coproporphyrins in PCT
Treatment for PCT?
- Stop drinking alcohol
- Stop all estrogen use
- Use barrier sun protection
- Use phlebotomy to remove iron, if not possible, use Deferoxamine
- Chloroquine increases excretion of porphyrins
Acute urticaria is a _______ reaction
Hypersensitivity
