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Dermatology

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Blistering Diseases

Question
26 out of 32
 

An old man in good health has tense bullous lesions over the thigh and abdomen with itching. There is no involvement of the mucosa of the mouth. The diagnosis is (AIPG 2010)



A Bullous pemphigoid
B Pemphigus vulgaris

C Pemphigus foliaceus
D Dermatitis herpetiformis

Ans. A
[Bullous-pemphigoid]

Bullous pemphigoid

Dermatitis- herpetiformis

Age

Common in old age

Most patients are adult

Presentation

Tense large blisters

Severely itchy papular urticarial,

Present all over the body

papulo-vesicular or bullous

Mucous membrane is not

Involvement

Involvement of buttocks and

No acantholysis and Nikolsky’s

sparing of the face are frequently seen

sign negative

Mucous membranes are only rarely involved

Antibody against

Dermo-epidermal basement

Dermo-epidermal junction

Direct immunoflurance

Membrane

Test

Deposition of IgG antibodies

Deposition of IgA antibodies (AI- 04)

• Dermatitis-herpetiformis - have mild GI absorptive defect due to gluten enteropathy * as in patients with coeliac disease

**Some disease with an immuno pathogenetic component are more common in patients with DH, including, thyrotoxicosis, RA, M. gravis and ulcerative colitis.

Extra Edge: BULLOUS PEMPHIGOID (Senile pemphigoid)

1). Sub-epidermal blisters with regeneration (non-acantholytic).

2). Eosinophil rich [Pruritus+ ] & tense bulla

3). Seen in elderly >60 year

4). Auto-antibody against: Hemi-desmosome

5). Complement C3 & linear IgG - antibodies seen in Basement membrane zone

6). Usually on Lower abdomen (rare in oral cavity)

7). No scar is left behind the blister (Healing without scarring).

8). T/t: prednisolone (much lower doses than P.V.)

9). Nikolsky -ve.

Blistering Diseases Flashcard List

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