Vesicular Bullae and Desquamation

Question 1

Define Bullous Pemphigoid

Answer 1

A chronic, autoimmune, inflammatory, subepidermal, blistering disease. Autoantibodies attach to the skin basement membranes and active inflammation

Question 2

Identify the study/procedure used to diagnose Bullous Pemphigoid

Answer 2

Requires 2 biopsies
1) Regular specimen from edge of a blister
2) Specimen for Direct Immunofluorescence taken from normal appearing skin located near the blister
*Can do blood testing, but it is not as accurate as skin biopsy

Question 3

List the first line treatments for Bullous Pemphigoid

Answer 3

• Oral steroids (Prednisone)
  OR
• Oral antibiotics (Tetracycline) if patient cannot take oral steroids

Question 4

Differentiate Bullous Pemphigoid and Pemphigus

Answer 4

Pemphigus: blisters occur on skin AND in mucous membranes, lesions are painful, patients are usually younger, associated with cancer

Question 5

Describe the characteristic lesion of Erythema Multiforme

Answer 5

Target shaped lesions: clear center with erythematous rings

Question 6

Identify the most common cause of Erythema Multiforme

Answer 6

Herpes Simplex Virus (HSV)

Question 7

List the clinical features of SJS and TEN

Answer 7

Prodromal Symptoms (1-3 days before any skin eruption)
- Fever
- Productive cough
- Headache
- Malaise
- Arthralgias

Mucocutaneous (mouth, esophagus, genital) onset is abrupt and may occur before skin eruption.

Rash can begin flat then become raised, then become bullies and rupture.

Fever, orthostasis, tachycardia, hypotension, altered level of consciousness, epistaxis, conjunctivitis, corneal ulcerations, erosive vulvovaginitis or balanitis, seizures, coma

Question 8

Identify the classifications of medications most commonly implicated in SJS and TEN

Answer 8

• Sulfa Abx
• NSAIDS
• Anti Gout
• Psychoepileptics

Question 9

Differentiate between SJS and TEN

Answer 9

SJS: affects <10% BSA
TENS: affects >30% BSA

Question 10

Calculate Body Surface Area using the Rule of 9s

Answer 10

• Palm of hand = 1%
• Anterior head = 4.5%
• Posterior head = 4.5%
• Anterior chest = 9%
• Posterior chest = 9%
• Anterior arm = 4.5%
• Posterior arm = 4.5%
• Anterior abdomen = 9%
• Posterior abdomen = 9%
• Groin = 1%
• Anterior leg = 9%
• Posterior leg - 9%

Question 11

Identify treatments of SJS and TEN

Answer 11

• Burn unit or ICU
• # 1: eliminate offending drug
• Labs (CBC, Metabolic Panel, Cultures)
• Wet dressings on skin
• Nutritional support
• Consults
• Pain control
• Treat secondary infections