Workshop: Blisters

Question 1

Write down your descriptions a

Answer 1

tense blister

clearly defined. on normal skin (not dermatitic skin)

Question 2

Write down your descriptions

Answer 2

tense blisters on an erythematous backgound. surrofund skin looks to be small, raised, erythematous papules coalescing into plaques or patches.

Question 3

Write down your descriptions

Answer 3

tense bulla on skin of color background. evident erosions seen; most likely due to breakage of blister. significant pock and scarring marks along the skin resulting in hypopigmented patches

Question 5

• 54yo M with a 4 month history of painful and itchy rash
• Has been to a walk-in clinic twice and last night went to the ED for his rash
• Was told it was reaction to hot tub, psoriasis and topical steroids were prescribed
• He is otherwise healthy and takes no medications
• Rash is getting so severe, he is feeling unwell and in a lot of pain, also getting oral ulcers and can no longer eat without pain in his mouth
• Waking up at night with blood on his sheets

Answer 5

flaccid bulla with many erosions. significant hyperpigmentation of the epidermis– possibly scarring or necrotic.

pemphigus vulagris– autoimmune blistering skin disease

Question 6

Answer 6

pemphigoid. flaccid bulla and oral ulcers

Question 7

mechanisms for pemphigus vs bullous pemphigoig

Answer 7

pemphigus= flaccid blister = lose keratinocyte adhesion = autoantibody targets desmosomes

bullous pemphigoig = tense blister = lose adhesion of epidermis to dermis in basement membrane zone = autoantibody targets hemidesmosome

Question 8

Bullous pemphigoid:

• Elderly, generalized pruritic chronic bullous eruption
• Most common autoimmune subepidermal blistering disease
• Tissue bound and circulating antibodies directed against basement membrane ____ proteins.

keratinocytes are not able to adhere to the ____ ____ but they can _______________ = resulting in _____ blisters

Answer 8

Bullous pemphigoid:

• Elderly, generalized pruritic chronic bullous eruption
• Most common autoimmune subepidermal blistering disease
• Tissue bound and circulating antibodies directed against basement membrane hemidesmosome proteins.

keratinocytes are not able to adhere to the basement membrane but they can hold onto each other = tense blisters

Question 9

in pemphigus, keratinocytes are not able to _________________, resulting in ___ erosions. the skin seems to be falling apart.

in pemphigus vulgaris, it involves ___ ___.

Answer 9

in pemphigus, keratinocytes are not able to adhere to each other, resulting in flaccid erosions. the skin seems to be falling apart.

in pemphigus vulgaris, it involves oral mucosa.

• The keratinocytes are not able to adhere together appropriately but
basement membrane is intact so creates superficial erosions

Question 10

drugs known to induce autoimmune bullous disease

Answer 10

diuretics–furosemide, spironolactone

captopril

penicillamine

Question 11

Answer 11

pemphigus vulgaris– flaccid bulla because the keratinocytes cannot adhere to one another, causing erosions

Question 12

• 28yo F with 3 year history of intensely itchy elbows and buttocks
• The skin at the site seems fragile and crusty but she has never noticed blisters
• She thinks she must have irritable bowel syndrome but has never been formally diagnosed or evaluated

Answer 12

small, irregular, erythematous papules in clusters. erosions might be present as evidenced by scabbing.

kind of clustered together in a herpetiform pattern.

she noted to have IBS– this might be a celiac issue!! she might have dermatitic herpatiformis

Question 13

this person has “IBS”

Answer 13

Dermatitis Herpetiformis= skin manifestation of celiac disease

• Symmetric elbows, extensors forearms, back,
buttocks, knees, scalp

• Urticarial plaques, papules, vesicles- grouped

• Intense pruritus, excoriation and crusting