Immunobullous

Question 1

Drug causes of BP

Answer 1

Fluid Sores Are Caused By Naughty Prescription Drugs (2 ab’s)

• frusemide
• spironolactone
• ACEi
• ciprofloxacin
• B blockers
• NSAIDs
• penicillins
• diabetic (gliptins)

Question 2

Drug causes of EBA

Answer 2

“VPG” (3 ab’s)

• vancomycin
• penicillin
• gentamicin

Question 3

drug causes of linear IgA

Answer 3

Very Straight Blisters CAN Pop (4 Abs)

• vancomycin
• statins
• Bactrim (THINK “BAP” like pop)
• Cephalosporins
• Anticonvulsants (V for vanc and vulsants)
• NSAIDs
• Penicillin

Question 4

BP Associations/triggers

Answer 4

Neurodegenerative conditions (dementia, parkinson’s, stroke, cognitive impairment, epilepsy)
Psychiatric (bipolar)
Malignancy (rare)
DM, RA, UC, LP, psoriasis
Triggers - trauma, UV, XRT, immunisation, burns, skin grafting, infection, DRUGS

Question 5

Epidemiology of BP

Answer 5

Disease of elderly (70-85 years)

F>M

Question 6

Histological findings in BP

Answer 6

Depends on lesion

• • pre-bullous = eosinophilic spongiosis
• • bullous = subepidermal blister with eosinophils, lining up along DEJ, dense eosinophilic infiltrate papillary dermis + neuts/macrophages/ lymphocytes

Question 7

DIF of BP

Answer 7

Linear IgG +/- C3 (» IgA, IgE)

— this is n-serrated pattern (as for all except EBA + bullous SLE which are u-serrated)

Question 8

Ix in BP

Answer 8

Lesional for histo
Perilesional for DIF
Salt-Split skin (staining of roof of blister)
Tzanck smear - ?eos
Blood for IIF including ELISA for which

Question 9

Subtypes of BP

Answer 9

Classic bullous
Pre-bullous
Eczematous
Prurigo-nodule like
Localised pretibial
Pemphigoid vegetans
Dyshidrotic
TEN-like
Pruritus sine materia (pruritic nonbullous pemphigoid)

Question 10

Clinical features BP

Answer 10

Classic = urticated erythematous patches w tense bullae
Nikolsky negative
Predilection for flexures, abdomen
Minority (10-20%) have mucosal involvement
50% have peripheral eosinophilia
Heals w/o scarring

Question 11

Mx of BP

Answer 11

General measures, topical agents, consider adm, monitor for complications
Sterile pop blisters, dressings
Tx according to severity/ BSA
Topicals (up to 30% though consider systemic for 10-30% BSA)
Systemics - PADD The MMRI
- prednisone (0.5-1mg/kg/day)
- azathioprine (2.5mg/kg/day if N TPMT)
- doxycycline 100-200mg/day + nicotinamide 500mg TDS
- dapsone 75-100mg/day (if N G6PD)
- Mtx (10-20mg/week)
- MMF 1.5g BD
- rituximab 1g week 0 + week 1 (or 375mg/m2)
- IVIg 2g/kg split over 3-5 days, monthly