Vesicular Bullae and Desquamation

Question 1

What is a bullous pemphigoid?

Answer 1

• chronic, autoimmune, inflammatory, subepidermal, blistering disease

Question 2

What are the clinical features of a bullous pemphigoid?

Answer 2

• tense bullae, usually in the flexural areas
• acute or subacute onset
• intense pruritis
• uncommon intra-oral lesions

Question 3

What is the treatment for bullous pemphigoid?

Answer 3

• oral steroids (prednisone) + antibiotics (abx taper)
• immunosuppressives
• prevent infections

Question 4

What is erythema multiforme?

Answer 4

• acute inflammatory skin disease secondary to HSV

Question 5

Describe the clinical features of erythema multiforme?

Answer 5

• symmetric erythematous skin lesion

- clear center with erythamatous rings

Question 6

Where do erythema multiforme lesions form?

Answer 6

• anywhere: extensor surfaces, palms, soles, mucuous membranes

Question 7

What is the treatment for erythema multiforme?

Answer 7

• supportive measures

- treat HSV infection

Question 8

What are the characteristics of Stevens Johnsons Syndrome (SJS)?

Answer 8

• blisters
• epidermal detachment
• epidermal necrosis

Question 9

What % BSA is affected?

Answer 9

• <10

Question 10

What are the causes of SJS?

Answer 10

• # 1 medications
• infection
• malignancy
• idopathic

Question 11

What are the clinical features of SJS?

Answer 11

• prodromal symptoms
• abrupt mucocutaneous onset
• non-pruritic
• painful
• rash

Question 12

Describe the rash associated with SJS

Answer 12

• macules develop into papules, vesicles, bullae, urticarial plaques, or confluent erythema

Question 13

Describe the center of the SJS lesions

Answer 13

• vesicular
• purpuric
• necrotic

Question 14

What can happen to the SJS lesions?

Answer 14

• bullous then rupture

Question 15

What is the treatment for SJS?

Answer 15

• patients should be in a burn unit
• eliminate causative drug
• fluid/electrolytes
• wet dressings
• nutritional support via parenteral nutrition
• optho consult
• pain control
• secondary infection treatment

Question 16

What is Toxic Epidermal Necrolysis (TENS)?

Answer 16

• potentially life-threatening disorder

Question 17

What are the clinical features of TENS?

Answer 17

• widespread erythema
• necrosis
• bullous detachment of the epidermis, external and internal mucous membranes

Question 18

What can massive exfoliation lead to?

Answer 18

• sepsis and death

Question 19

What % of BSA if affected in TENS?

Answer 19

• > 30%

Question 20

What is the most common etiology of TENS?

Answer 20

• medications

Question 21

Describe the TENS lesion

Answer 21

• poorly defined
• erythamtous macular rash
• purpuric centers

Question 22

What happens to the TENS rash after the first day or two?

Answer 22

• rash coalesces to form flaccid blisters and sheetlike epidermal detachment

Question 23

Nikolsky sign

Answer 23

• application of slight lateral pressure to the epidermal surface results in the epidermis easily separating from its underlying surface
• skin peels with slight lateral pressure

Question 24

How is TENS treated?

Answer 24

• burn unit with isolation room to decrease infections
• remove offending drug
• fluid/electrolytes
• T regulation
• nutritional support
• pain control
• skin dressings

Question 25

What is the cause of death with TENS patients?

Answer 25

• sepsis

- mulit organ failure

Question 26

How do you estimate burn area?

Answer 26

• Rule of 9s

Question 27

What is the rule of 9s?

Answer 27

• head 9%
• ant/post torso 18% each
• UE 9% each
• LE 18% each
• genitals 1%