Vascular diseases of the skin Flashcards
What are the two antigens that hold the epidermis to the BM?
BPAG1 and BPAG2
What is the pathophysiology of bullous pemphigoid?
Attack against the BPAG1 and BPAG2
What are the three major locations for blisters?
- Subcorneal
- Intraepidermal
- Subepidermal
What is the direct immunofluorescence tool used to diagnose skin disorders?
Abs against patient’s perilesional skin helps diagnose
What is indirect immunofluorescence tool to diagnose skin disorders?
Circulating Ab in patient’s serum against normal skin
What is the most common bullous autoimmune disease?
Bullous pemphigoid
What is Bullous pemphigoid?
Type II hypersensitivity, Blistering skin disease
What age range is generally affected with bullous pemphigoid?
60-80+
Which gender is usually more affected with bullous pemphigoid?
Equal
What is the pathophysiology of bullous pemphigoid?
Autoantibody against antigens BP180 (BPAG1) and BP230 (BPAG2)
What are the skin findings with bullous pemphigoid?
Urticarial/papular lesions that progress to tense bullae
What are the s/sx of bullous pemphigoid?
- Urticarial/papular lesions
- Itchy
- bullae arise in normal or erythematous skin
What areas of the skin are not affected with bullous pemphigoid?
Mucosal surfaces
What is the natural history of bullous pemphigoid?
Evolves over weeks/months to a generalized bullous eruption
Tense bullae arising in tense or erythematous skin = ?
bullous pemphigoid
What is the major difference in skin involvement between bullous pemphigoid and bullous pemphigus?
bullous pemphigoid does NOT involved mucosal surfaces
Pemphigus does
What type of hypersensitivity reaction is bullous pemphigoid?
Type II
What is erythrodermic bullous pemphigoid?
Body wide distribution of bullous pemphigoid
What is spongiosus?
A lot of edema between cells of the epidermis
What is the initial histological finding of bullous pemphigoid?
Inflammation of the epidermis, with eosinophils surrounding
What is the direct immunofluorescence finding in bullous pemphigoid?
Linear deposition of IgG and C3 along the BM zone
Linear deposition of IgG and C3 along the BM zone = ?
bullous pemphigoid
What is the treatment for bullous pemphigoid?
Systemic steroids or other immunosuppressants
If local, then local steroids
True or false: there is often a lot of skin scarring with bullous pemphigoid
False–no scarring
How do you follow a patient with bullous pemphigoid?
Serum antibodies to BP180 and BP230
What is cicatricial pemphigoid?
Rare variant of bullous pemphigoid of the elderly that affects mucosal surfaces, usually of the head and neck.
What is the natural h/o cicatricial pemphigoid?
Chronic and recurring course
True or false: there is often scarring with cicatricial pemphigoid
True
What is the treatment for cicatricial pemphigoid?
Immunosuppressives
What should always be done when a patient complains of pruritus anywhere?
Look at mucosal surfaces
What are the differences between cicatricial pemphigoid and bullous pemphigoid?
none
What is pemphigoid gestationis?
Rare, intensely pruritic dermatosis of pregnancy
What are the skin findings with pemphigoid gestationis?
vesicular eruptions on abdomen with sparing of mucous membranes
When in gestation does pemphigoid gestationis often occur?
4th-7th month
Which ethnicity is usually affected with pemphigoid gestationis?
Whites
True or false: pemphigoid gestationis can recur in subsequent pregnancies
True
What percent of babies born to mother with pemphigoid gestationis develop the skin disease? What is the prognosis?
5%
Typically resolves 6 months postpartum
What is the management for pemphigoid gestationis?
Systemic prednisone to suppress blisters and relieve itching
Bullous lesions affecting the abdomen of a pregnant woman = ?
pemphigoid gestationis
Does pemphigoid gestationis involved the umbilicus?
Yes–if not, think of other things
What are the histological findings of pemphigoid gestationis?
Same as bullous pemphigoid
What is pruritic papules and plaques of pregnancy? How can you differentiate this from pemphigoid gestationis?
Appears in the striae, and is umbilical SPARING
-no blisters
What is the histology like with PUPP?
Dermatitis-like
What are the DIF findings in PUPP?
Negative
What is pregnancy prurigo?
Non-blistering skin disorder that arises in pregnancy
What are the histological findings of pregnancy prurigo?
Dermatitis pathology
What are the DIF findings in pregnancy prurigo?
Negative
What is the age range and gender that is usually affected with dermatitis herpetiformis?
20-60 year old males
What are the skin findings of dermatitis herpetiformis?
- Papules
- Vesicles
- Occasional bullae on an erythematous, often urticarial base
Is dermatitis herpetiformis pruritic?
Yes
What is the treatment for dermatitis herpetiformis? (2)
- Gluten free diet
- Dapsone
What disease is dermatitis herpetiformis commonly associated with?
Celiac disease
Which ethnicity is affected with dermatitis herpetiformis?
Caucasians
What area of the body is usually affected with dermatitis herpetiformis, that other skin diseases do not usually affect?
Extensor surfaces of elbow and knees
What is the pathogenesis of dermatitis herpetiformis?
Antibodies against tissue transglutaminase (TTG) bing to TTG in the gut, circulate to the skin, and activate PMNs
How can you follow the course of dermatitis herpetiformis?
Follow TTG antibodies
What are the histological findings of dermatitis herpetiformis?
Subtle subepidermal blisters, filled with PMNs
What are the DIF findings of dermatitis herpetiformis?
Granular IgA deposition in dermal papillae
What is adult linear bullous dermatosis?
An acquired, autoimmune blistering disease that may present with a clinical pattern of vesicles indistinguishable from dermatitis herpetiformis, or with vesicles and bullae in a bullous pemphigoid-like appearance
What is childhood linear bullous dermatosis?
An acquired, self-limited bullous disease that may begin by the time the patient is age 2 to 3 and usually remits by age 13
What areas of the body are affected with linear bullous dermatosis?
Trunk and mucous membranes
What are the skin findings of linear bullous dermatosis?
Group vesicles (“cluster of jewels”)