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Dermatology - Clinical Medicine IV > Bullous Diseases > Flashcards

Flashcards in Bullous Diseases Deck (27)
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1

Autoimmune, blistering skin disease
IgG mediated

bullous pemphigoid

2

What happens in bullous pemphigoid?

Autoantibodies bind to skin basement membrane
Creates inflammatory reactions that creates blisters

3

What is the epi of bullous pemphigoid?

uncommon, 5th-7th decage = avg age 65

4

What are the triggers of bullous pemphigoid?

UV irradiation
Xray therapy
Drugs- furosemide, ibuprofen, captopril, antibiotics (penicillamine

5

What is the clinical presenation of bullous pemphigoid?

Widespread, tense blisters
Associated with prodromal eruption

6

What are some common sites of bullous pemphigoid?

Axillae, medial thighs, groin, abdomen, forearms- flexor surfaces
Lower legs- often first site
Mucous Membranes- rare

7

What PE do you do for bullous pemphigoid?

Preceding lesion
Weeks to months prior
Various sizes
Serous or hemorrhagic fluid

8

What is the workup for bullous pemphigoid?

biopsy with DIF studies, ELISA

9

What is the treatment for bullous pemphigoid?

Glucocorticoids
Prednisone
Immunosuppressants
Azathioprine (Imuran)
Biologics
Rituximab (Rituxan)
Treat secondary infection

10

What is the prognosis of bullous pemphigoid?

long term remssion after tx

11

What is pemphigus?

Autoimmune
IgG bind to desmogleins (cell to cell adhesions)
Keratinocytes can’t bind leading to split in epidermis/mucosal epithelium

12

What are the two types of pemphigus?

vulgaris
foliaceus

13

What is PV?

serous fliud filled vesicles and bulla affecting oral mucosa

14

How does PV present?

painful

15

What is the sign for PV?

Nikolsky sign

16

What are the sites you get PV?

scalp, face, chest, axillae, groin, umbilicus

17

What is vegetative pemphigus vulgaris?

PV lesions from vegetating granulations

18

What is PF?

Bullae transform to scaly, crusted erosions
No mucosal lesions
Erythematosus base

19

What are common sites for PF?

face, scalp, upper trunk

20

What are teh variations of pemphigus foliaceus?

Pemphigus erythematosus
Pemphigus herpetiformis
Endemic pemphigus foliaceus
IgA pemphigus foliaceus
Drug induced pemphigus foliaceus

21

What is the work up for pemphigus?

Direct immunofluorescence (DIF)- autoantibodies
Indirect immunofluorescence
ELISA

22

What is the treatment for pemphigus?

Need to be aggressive
Glucocorticoids
Prednisone 2-3 mg/kg daily until new blister formation stops
Immunosuppressive therapy
Methotrexate, Rituximab
Antibiotics- if indicated
Wound care
Cleansing baths; dressing changes; Fluid/electrolyte balance

23

What is dermatitis herpetiformis?

Autoimmune- IgA deposits in dermis
Associated with gluten-sensitive enteropathy

24

What do the lesions in dermatitis herpetiformis?

Grouped erythematous papules or wheals
Topped with vesicles
Excoriation and crusts
Extremely pruritic
Burning, stinging, itching before lesions appear

25

What is the epi of dermatitis herpetiformis?

11/100K, men more, 2-4th decade

26

What is the work up for DH?

skin biopsy

27

What is the treatment for DH?

Avoid gluten
Diaminodiphenyl (Dapsone)
sulfapyridine