Trigger - Bullae Flashcards
2/2 Autoantibodies of the IgG class that attatch to desmogleins and inhibit desmosomes from aiding in cell adhesions causing acantholysis
pemphigus
flaccid blisters on the skin with erosions on mucous membranes
pemphigus vulgaris
typically begins in the oral mucosa
pemphigus vulgaris
Pt presenting with mouth ulcers that burn. also reports recent nose bleeds and decreased oral intake which has lead to weakness, malaise, and weight loss. what could this possibly be?
pemphigus vulgaris mouth ulcers!
there is NO mucosal involvement in which pemphigus?
foliaceus
Biopsy at the edge of a blister showing (+) deposits of IgG
pemphigus
Direct immunofluorescence staining (DIF) of normal appearing skin adjacent to a lesion showing IgG and C3.
pemphigus
ELISA results shows a (+) a-Dsg1 but a (-) a-Gsg3. what is the diagnosis
Pemphigus foliaceus
if 3 is positive its always vulgaris
this diagnosis has a prodrome of pruritus, urticaria and papular lesions that lasts from weeks to months
bullous phemigoid
Interaction of autoantibody with BP antigen.
bullous phemigoid
large, tense, firm topped bullae with serous or hemorrhagic fluid that has a negative nikolsky sign
bullous phemigiod
Biopsy of perilesional skin showing linear IgG deposits or C3 along basement membrane.
bullous phemigoid
gold standard
direct immunoflorescence study is done to confirm what diagnosis
phemigoid diagnoses
Acute hypersensitivity reaction affecting the skin and mucous membranes
erythema multiforme
erythematous papular or urticarial lesions tha later become bullae that are pruritic and painful
erythema multiforme
can be serous or hemorrhagic
can present as corneal ulcers or anterior uveitis
erythema multiforme
presents with fever, weakness, malaise, and fatigue
erythema multiforme
this bullous disease is known to be bilateral and symmetrical
erythema multiforme
A patient has bilateral symmetric vesicles that have appeared on his face and upper extremities. he denies fever or mucosal involvement. what is his diagnosis? how would you treat him?
MILD erythema multiforme
Tx: antihistamines, low dose topical CS, valcyclovir if viral
if there is a LITTLE mucosal involvement you can do HIGH dose steroid gel
A pt has symmetric and bilateral vesicles and bullae that are widespread over his upper and lower extremities, chest and groin area. He reports fever and malaise. What is your diagnosis and tx.
Dx: major erythema multiforme
tx: IVF, magic swizzle, prednisone, burows solution wet compresses.
Pt presents with bilateral vesicular lesions around the eyes and across the face. On ocular exam you see anterior uveitis. What is the diagnosis and treatment
Dx: major erythema multiforme
tx: concult oph immediatly
topical low dose steroids for vesicles on face
when do you use daily antivirals
recurrent erythema multiforme
what is the MCC of major erythema multiforme
drug reactions!
what is the compound topical oral solution (magic swizzle/throat soothie) formula
1:1 viscous lido/benadryl/Maalox/(+/-) dexamethasone Swish, gargle, spit
skin tenderness followed by target lesions with rapid confluence and a positive nikoslies sign.
SJS/TEN
A patient has massive desquamation that has now progressed to sloughing of the epidermis. He has a fever and his HR is 134. what is the dx
EMERGENT SJS/TEN
fever, HR>120, sloughing = emergent
Classify SJS, SJS/TEN, and TEN
treated with prednisone + azothioprine
bullous phemigoid
also the treatment for phemigus vulgaris! (can also use cellcept instead of azothioprine for this one)
Cytotoxic event caused by immune response destroying keratinocytes
SJS/TEN
Non-adherent dressings for the eye made of saline and erythromycin ointment is used in what diagnosis
SJS/TEN with eye involvement
Treated with IV steroids and IVIG
SJS/TEN
