Vesiculobullous Diseases

Question 1

Highly contagious superficial skin infection. Rapid blister, asx, FLACCID

Answer 1

Impetigo.

“Honey crusted lesion”

Bullous impetigo.

Question 2

Most common causes of impetigo

Answer 2

Staph aureus or Strep pyogenes. Infect skin breaks (i.e. due to atopic dermatitis, herpes infection, trauma).

Question 3

Tx of impetigo

Answer 3

antibiotics

Question 4

Toxin mediated exfoliative dermatitis. Exotoxin destroys keratinocyte attachments in straum granulosum only, Fever, orange/red macules, sloughing of upper layers of epidermis. Children/infants/daycares/renal failure.

What is this?
Physical exam sign

Answer 4

Staph Scalded Skin Syndrome

+ Nikolsky sign (rubbed area of skin sloughs off)

Question 5

Pathogenesis of SSSS

Answer 5

Staph aureus, type 2

Question 6

Skin and oral mucosa with flaccid intraepidermal bulla. IgG autoantibody against Desmoglein 3

Answer 6

Pemphigus Vulgaris

Question 7

Physical exam signs of Pemphigus Vulgaris

Answer 7

+ Nikolsky (rubbed area of skin sloughs off)

+ Asboe-Hansen Sign (lateral prssure on bulla will spread bulla to uninvolved skin)

Question 8

What disease is associated with PV?

Dx and tx of Pemphigus Vulgaris?

Answer 8

Myasthenia gravis and thymoma are associated with PV.
Dx - biopsy
Tx - imuran, prednisone, Consult opthomology

Question 9

Encephalitis, seizures, HA. Spread by respiratory droplets or genetalia contact. Prodrome: itching/burning. Vescicles/ulcer on erythematous base, recurrent.

What is this?

Answer 9

HSV1 (oral)

HSV2 (Gentalia)

Question 10

What is herpetic whitlow and herpes gladitorum

Answer 10

Whitlow - herpes n finger

gladitorium - along ears, in wrestlers

Question 11

“Dew drop on rose petal” or “oval teardrop on erythematous base”.
Face/trunk, aphthous ulcers, spares distal extremities.

Answer 11

Varicella Zoster virus (chickenpox).

Question 12

Do not give what to to peds with VZ Virus

Tx

Answer 12

Aspirin

Tx - VZIG, antivirals, antihistamines

Question 13

Autoantibodies of IgG against __ antigens 1 and 2. Chronic, autoimmune, SUBepidermal blistering.

Tense bulla containing eospinohils.

Answer 13

Bullpous pemphigoid.

Question 14

Immunofluorescence of BP.

tx of bullous pemphigoid

Answer 14

Linear pattern

prednisone, immunosuppressives

Question 15

Type 4 HSR. Idiopathic photodermatoses relating to sun exposure (UV-A or UV-B). Native American! Spring time! 30 min after sun exposure.

Answer 15

Polymorphous Light Eruption

Question 16

Rare immune mediated skin disease with gluten sensitive enteropathy. IgA mediated (dermal papilla).

Answer 16

Dermatitis Herpetiformis

Question 17

A person presents with pruritic, grouped/symmetric/burning skin blisters. Urticarial wheal to vescicle to bulla.

What is this?

What immunologic markers?

Answer 17

Dermatitis Herpetiformis

Increased expression of HLA-B1, B8, DR8, DRQ

Question 18

Tx of dermatitis herpetiformis.

Answer 18

dapson, gluten free diet

Question 19

B9, self limiting eruption. Targetoid or iris shaped macules or vesiculopapules on palms or soles. Dull red, sometimes mucosal involvent, symmetric involvement.

What is this?
What associated phenomenon? Associated infection?

Answer 19

Erythema multiforme

Koebner phenomenon

HSV

Question 20

The major variant of Erythema Multiforme must be hospitalized bc…

Answer 20

affects oropharynx

Question 21

Extensive full thickness skin attachment. 1-3 week prodrome with fever, skin tenderness/pain, crinkled surface. Associated with HLA-B12, worse in SLE, HLA, meds/infections.

What is this?
What sign is associated with it?

Answer 21

Toxic Epidermal Necrolysis

+Nikolsky

Question 22

Tx of TEN

Answer 22

IV fluids, burn unit, steroids as last resort.