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Dermatology - Clinical Medicine IV > Bullous Diseases > Flashcards

Flashcards in Bullous Diseases Deck (27)
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1
Q
Autoimmune, blistering skin disease
IgG mediated
A
bullous pemphigoid
2
Q
What happens in bullous pemphigoid?
A
Autoantibodies bind to skin basement membrane
Creates inflammatory reactions that creates blisters
3
Q
What is the epi of bullous pemphigoid?
A
uncommon, 5th-7th decage = avg age 65
4
Q
What are the triggers of bullous pemphigoid?
A
UV irradiation
Xray therapy
Drugs- furosemide, ibuprofen, captopril, antibiotics (penicillamine
5
Q
What is the clinical presenation of bullous pemphigoid?
A
Widespread, tense blisters
Associated with prodromal eruption
6
Q
What are some common sites of bullous pemphigoid?
A
Axillae, medial thighs, groin, abdomen, forearms- flexor surfaces
Lower legs- often first site
Mucous Membranes- rare
7
Q
What PE do you do for bullous pemphigoid?
A
Preceding lesion
Weeks to months prior
Various sizes
Serous or hemorrhagic fluid
8
Q
What is the workup for bullous pemphigoid?
A
biopsy with DIF studies, ELISA
9
Q
What is the treatment for bullous pemphigoid?
A
Glucocorticoids
Prednisone
Immunosuppressants
Azathioprine (Imuran)
Biologics
Rituximab (Rituxan)
Treat secondary infection
10
Q
What is the prognosis of bullous pemphigoid?
A
long term remssion after tx
11
Q
What is pemphigus?
A
Autoimmune
IgG bind to desmogleins (cell to cell adhesions)
Keratinocytes can’t bind leading to split in epidermis/mucosal epithelium
12
Q
What are the two types of pemphigus?
A
vulgaris
foliaceus
13
Q
What is PV?
A
serous fliud filled vesicles and bulla affecting oral mucosa
14
Q
How does PV present?
A
painful
15
Q
What is the sign for PV?
A
Nikolsky sign
16
Q
What are the sites you get PV?
A
scalp, face, chest, axillae, groin, umbilicus
17
Q
What is vegetative pemphigus vulgaris?
A
PV lesions from vegetating granulations
18
Q
What is PF?
A
Bullae transform to scaly, crusted erosions
No mucosal lesions
Erythematosus base
19
Q
What are common sites for PF?
A
face, scalp, upper trunk
20
Q
What are teh variations of pemphigus foliaceus?
A
Pemphigus erythematosus
Pemphigus herpetiformis
Endemic pemphigus foliaceus
IgA pemphigus foliaceus
Drug induced pemphigus foliaceus
21
Q
What is the work up for pemphigus?
A
Direct immunofluorescence (DIF)- autoantibodies
Indirect immunofluorescence
ELISA
22
Q
What is the treatment for pemphigus?
A
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
Q
What is dermatitis herpetiformis?
A
Autoimmune- IgA deposits in dermis
Associated with gluten-sensitive enteropathy
24
Q
What do the lesions in dermatitis herpetiformis?
A
Grouped erythematous papules or wheals
Topped with vesicles
Excoriation and crusts
Extremely pruritic
Burning, stinging, itching before lesions appear
25
Q
What is the epi of dermatitis herpetiformis?
A
11/100K, men more, 2-4th decade
26
Q
What is the work up for DH?
A
skin biopsy
27
Q
What is the treatment for DH?
A
Avoid gluten
Diaminodiphenyl (Dapsone)
sulfapyridine