Vesicular Bullae Flashcards
Blistering disease - Detachment of epidermis from dermis
Large, tense blisters on an erythematous base
Autoimmune disorder of unknown cause
No systemic involvement
Age of onset: >60
Equal in males and females
Bullous Pemphigoid
Blister formation is believed to begin with binding of IgG to bullous pemphigoid Ag, activation of complement, infiltrates of neutrophils and eosinophils (Inflammatory reaction directed against structural proteins)
Often starts with a prodromal eruption (urticarial, popular lesions) and
evolves in weeks to months to bullae
Bullous Pemphigoid
How is bullous pemphigoid diagnosed?
Punch biopsy with immunofluroescence
What are the treatment options for bullous pemphigoid?
Usually self-limiting
Systemic prednisone
IVIG +/- Azathioprine (immunosuppressive agents)
Plasmapheresis (Reduces the amount of Ab out of the body)
This is an uncommon intraepidermal blistering disease occurring on
skin and mucous membranes
Cause is unknown
Several forms
Pemphigus
Insidious onset of flaccid bulla, crust, and erosions in crops and waves
Lesions often appear on the oral mucous membranes that rapidly become erosive
The scalp is another site of early involvement
Rubbing a cotton swab or finger laterally on the surface of uninvolved skin may cause easy separation of the epidermis
Pemphigus
List some conditions that should be in your differential diagnosis of Pemphigus
Erythema multiforme
Drug eruption
Bullous impetigo
Contact dermatitis
Dermis herpetiformis
Bullous pempigold
What is the treatment for pemphigus?
When severe, hospitalize the patient at bed rest and provide antibiotic and IV feedings as indicated
Systemic treatment
Azathroprine or mycophenolate mofetil (immunosuppressant) - If fails, IVIG at 2g/kg
In patients with limited disease, skin and mucous membrane lesions should be treated with topical steroid
