Bullous Diseases

Question 1

3 diseases with positive nikolsky sign

Answer 1

Pemphigus vulgaris
Staph scalded skin syndrome
Toxic epidermal necrolysis

Question 2

Bullous pemphigoid

Answer 2

• deep blisters, thick walled, less likely to rupture
• oral lesions are rare
• diagnosis: biopsy w/immunofluorescent ab
• treatment: steroids, tetracycline, erythromycin with nicotinamide
• causes: sulfa drugs

Question 3

Pemphigus foliaceous

Answer 3

• causes: autoimmune, ACEi, NSAIDs
• no oral lesions
• superficial so intact bullae not seen due to easily breakable
• diagnosis: biopsy
• treatment: steroids

Question 4

Porphyria cutanea Tarda

Answer 4

• d/o porphyrin metabolism causing photosensitivity rxn 2/2 high accumulation of porphyrins
• common associations: etoh, liver dz, chronic hep c, oral contraceptives, diabetes
• common sx: non healing blisters on sun exposed parts of body, hyper pigmentation of skin, hypertrichosis of face
• diagnosis: urinary porphyrins
• tx: stop etoh, stop estrogen use, use sun protection, use phlebotomy to remove iron or deferoxamine, chloroquine increases excretion of porphyrins

Question 5

Pemphigus vulgaris

Answer 5

• autoimmune
• ab to intercellular spaces of epidermal cells
• caused by: idiopathic, ACEi, penicillamine
• lesions are painful, not pruritic
• treatment: steroids, azothioprine, mycophenolate, cyclophosphamide