Vesicular & Bullous Diseasess

Question 1

What is Bullous Pemphigoid?
Where is it m/c located?
Who is it m/c in?

Answer 1

• SUBEPIDERMAL autoimmune blistering disease
• M/C on flexural surfaces (arms, legs, palms, soles), lower abdomen, groin
• M/C in elderly (>60)

Question 2

RF for Bullous Pemmphigoid?

Answer 2

• Neurological diseases (i.e Dementia & Parkinson’s)
• Ulcerative Colitis
• Lichen Planus
• Psoriasis

Question 3

M/C/C of Bullous Pemphigoid?

Answer 3

Drugs

Question 4

Is Bullous Pemphigoid itchy?

Answer 4

YES (mod-severe)

Question 5

Localized erythematous area with itchy urticarial plaque. Plaques turn dark red in 1-3 wks: Firm/tense vesicle –> rupture –> erosion. Oral lesions may be present.

Answer 5

Bullous Pemphigoid

Question 6

How can you differentiate Bullous Pemphigoid from other blistering diseases?

Answer 6

Negative Nickolsky sign (lesions do NOT shear off)

Question 7

How can you definitively diagnose Bullous Pemphigoid?

Answer 7

Skin Biopsy! –> H&E & Direct Immunofluorescence of perilesional skin

Question 8

How do you treat Bullous Pemphigoid?

Answer 8

• D/C offending drug!
• 1st line = Oral/topical steroids

Question 9

What is Pemphigus Vulgaris?
What is involved?
Where is it m/c located?

Answer 9

• INTRAEPIDERMAL autoimmune blistering disease
  (looser/more flaccid vesicles)
• Involves skin and mucosa (oral lesions may develop before skin lesions)
• M/C on proximal extremities and trunk

Question 10

Is there a Positive or Negative Nickolsky sign associated with Pemphis Vulgaris?

Answer 10

Positive (skin shears off)

Note: also Positive Asboe-Hansen sign

Question 11

How is Pemphigus Vulgaris diagnosed?

Answer 11

Skin Biopsy –> H&E and DIF

Question 12

How is Pemphigus Vulgaris treated?

Answer 12

Oral steroids

Question 13

Are oral lesions more or less common with Pemphigus Vulgaris compared to Bullous Pemphigoid?

Answer 13

More common!

Question 14

What is Dermatitis Herpetiformis?
Who is m/c affected?
What is it associated with?

Answer 14

• Chronic Autoimmune disease
• M > F, Caucasians 20-50
• Associated with Celiac Disease, Lymphoma, Hypothyroidism

Question 15

Is Dermatitis Herpetiformis itchy?

Answer 15

SUPER itchy vesicles

Question 16

What does the Dermatitis Herpetiformis rash look like?
Where is it M/C located?
Are oral lesions common?

Answer 16

• Clustered vesicles with excoriations
• Symmetrical (elbows, knees, sacrum, occiput)
• Oral lesions are NOT common