Vesicular Bullae and Desquamation Flashcards
What is a bullous pemphigoid?
- chronic, autoimmune, inflammatory, subepidermal, blistering disease
What are the clinical features of a bullous pemphigoid?
- tense bullae, usually in the flexural areas
- acute or subacute onset
- intense pruritis
- uncommon intra-oral lesions
What is the treatment for bullous pemphigoid?
- oral steroids (prednisone) + antibiotics (abx taper)
- immunosuppressives
- prevent infections
What is erythema multiforme?
- acute inflammatory skin disease secondary to HSV
Describe the clinical features of erythema multiforme?
- symmetric erythematous skin lesion
- clear center with erythamatous rings
Where do erythema multiforme lesions form?
- anywhere: extensor surfaces, palms, soles, mucuous membranes
What is the treatment for erythema multiforme?
- supportive measures
- treat HSV infection
What are the characteristics of Stevens Johnsons Syndrome (SJS)?
- blisters
- epidermal detachment
- epidermal necrosis
What % BSA is affected?
- <10
What are the causes of SJS?
- # 1 medications
- infection
- malignancy
- idopathic
What are the clinical features of SJS?
- prodromal symptoms
- abrupt mucocutaneous onset
- non-pruritic
- painful
- rash
Describe the rash associated with SJS
- macules develop into papules, vesicles, bullae, urticarial plaques, or confluent erythema
Describe the center of the SJS lesions
- vesicular
- purpuric
- necrotic
What can happen to the SJS lesions?
- bullous then rupture
What is the treatment for SJS?
- 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
What is Toxic Epidermal Necrolysis (TENS)?
- potentially life-threatening disorder
What are the clinical features of TENS?
- widespread erythema
- necrosis
- bullous detachment of the epidermis, external and internal mucous membranes
What can massive exfoliation lead to?
- sepsis and death
What % of BSA if affected in TENS?
- > 30%
What is the most common etiology of TENS?
- medications
Describe the TENS lesion
- poorly defined
- erythamtous macular rash
- purpuric centers
What happens to the TENS rash after the first day or two?
- rash coalesces to form flaccid blisters and sheetlike epidermal detachment
Nikolsky sign
- 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
How is TENS treated?
- burn unit with isolation room to decrease infections
- remove offending drug
- fluid/electrolytes
- T regulation
- nutritional support
- pain control
- skin dressings
What is the cause of death with TENS patients?
- sepsis
- mulit organ failure
How do you estimate burn area?
- Rule of 9s
What is the rule of 9s?
- head 9%
- ant/post torso 18% each
- UE 9% each
- LE 18% each
- genitals 1%
