Bullous Disorders Flashcards
Differences between bullous pemphigoid and pemphigus
Bullous pemphigoid - split is deeper through dermo-epidermal junction
Pemphigus - split is more superficial, intra-epidermal
Nikolsky’s sign
Top layers of the skin slip away from the lower layer when slightly rubbed
What does nikolsky’s sign indicate?
Plane of cleavage in the epidermis
Which age of patients tend to get bullous pemphigoid?
Elderly
Where do the blisters tend to be in bullous pemphigoid?
Localised to one area or widespread on the trunk and proximal limbs
Clinical features of bullous pemphigoid
Large, tense bullae on normal skin on erythematous base.
Blisters can burst to leave erosions
Itchy erythematous plaques and papules may be the presenting feature
Is nikolsky’s sign positive or negative in bullous pemphigoid?
Negative
Mucosal lesions are common/uncommon in bullous pemphigoid
Mucosal lesions are unlikely in bullous pemphigoid
Which areas do pemphigus vulgaris typically affect?
Scalp, face, axillae and groin
Clinical features of pemphigus vulgaris
Flaccid, vesicles/bullae with thin roof
Lesions rupture to leave raw areas
True or false: there is an increased risk of infection with pemphigus vulgaris
True
Nikolsky’s sign is positive/negative in pemphigus vulgaris
Nikolsky’s sign is positive in pemphigus vulgaris
Is mucosal involvement common or uncommon in pemphigus vulgaris?
Very common - eyes, genitals
Prognosis of bullous disorders
Duration varies from months to years and it is a self-limiting course. Most patients achieve remission on treatment between 3-6 months
Pemphigus - very high mortality if untreated
Bullous pemphigoid - much lower risk
Investigations for bullous disorders
Skin biopsy with immunofluorescence
Indirect immunofluorescence
