Blistering conditions Flashcards
What is bullous pemphigoid?
Blistering skin disorder which usually affects the elderly
Cause of bullous pemphigoid?
IgG Autoantibodies against antigens between EPIDERMIS and DERMIS
This causes sub-epidermal split in the skin
Presentation of bullous pemphigoid?
- Tense, fluid filled blisters on an erythematous base
- Lesions ae itchy
- May have non-specific itchy rash before blisters
- On trunk and limbs
- as blisters located at dermoepidermal junction, the blisters are usually intact (contrast to pemphigus vulgaris where they easily rupture as the defect is in intercellular spaces)
Management of bullous pemphigoid?
General: wound dressings, monitor for signs of infection
Topical therapies for local disease - topical steroids
Oral therapies for widespread disease - oral steroids (1st line prednisolone), oral tetracyclines, nicotinamide, immunosuppressive agents (e.g. methotrexate)
What is pemphigus vulgaris?
Blistering skin disorder affecting middle aged
Cause of pemphigus vulgaris?
Autoantibodies against antigens within the EPIDERMIS
This causes intra-epidermal split in the skin
Presentation of pemphigus vulgaris?
- Flaccid, easily ruptured blisters forming erosions and crusts
- Lesions are painful
- Affects mucosal areas (even before skin is involved!)
Management of pemphigus vulgaris?
General measures - wound dressings, monitor for infection, good oral care
Oral therapies - high dose oral steroids, immunosuppressive agents (methotrexate, azathioprine etc), biological agents
Investigations for bullous pemphigoid?
Skin biopsy for histology and immunofluorescence
- +ve immunofluorescense shows IgG and C3 along basement membrane at the dermoepidermal junction
Skin swab
- only if skin weepy to exclude a secondary skin infection
NOTE:
- histology rules out other skin conditions
- immunofluorescence needed to confirm autoimmune bullous disease (shows autoantibodies IgG and c3)
