1. what is a vesicle?
    • circumscribed skin lesion containing fluid
    • <5mm
  2. what is a bulla?
    • circumscribed skin lesion containing fluid
    • >5mm
  3. what is the most common cause of blistering in skin?
    extrinsic - eg trauma, burns, insect bites
  4. what are the inflammatory causes of blistering?
    eczema - pompholyx
  5. what are the infectious causes of blistering?
    • HSV
    • VZV
    • impetigo
  6. what are the autoimmune causes of blistering?
    • bullous pemphigus
    • bullous pemphigoid
  7. what are the main Ix done for blistering disease?
    • skin biopsy: haematoxylin & eosin; immunofluorescence (direct)
    • blood tests: immunofluorescence (indirect), porphyria screen
  8. what are the 4 main aspects of caring for blister patient?
    • DEROOF: puncture and deflate blister
    • potassium permanganate soaks
    • regular emollients
    • treat cause
  9. how do you treat pompholyx eczema?
    high dose steroids
  10. what age group does bullous pemphigoid occur in?
    older patients
  11. what is cause of bullous pemphigoid?
    • autoimmune
    • antibodies against
  12. how does bullous pemphigoid start?
    itchy, urticarial plaques in limbs
  13. what happens later in bullous pemphigoid? describe what you see
    develop TENSE intact blisters
  14. what is the distribution of rash in bullous pemphigoid?
  15. apart from skin where else may you see evidence of bullous pemphigoid?
    oral mucosa - rare
  16. what is the course of bullous pemphigoid?
    self limiting
  17. when can Rx for bullous pemphigoid be stopped?
    around 2 years
  18. what is Rx of bullous pemphigoid?
    deroof, soak in Kpermang, steroids
  19. what are the 3 complications of bullous pemphigoid?
    • discomfort
    • loss of fluid from ruptured bulla
    • infection
  20. which is more aggressive bullous pemphigoid or pemphigus vulgarise?
    pemphigus vulgaris
  21. what is the mortality rate of untreated pemphigus vulgarise?
    • 100%
    • highly aggressive
  22. where does pemphigus vulgaris start?
    oral mucosa - commonly affects mucous membranes (unlike pemphigoid)
  23. what is cause of pemphigus vulgaris? how common?
    • CHRONIC autoimmune
    • rare
  24. how would you describe the vesicles in pemphigus vulgaris? what does it feel to patient?
    • flaccid vesicles that form into erosions
  25. where is Rx of pemphigus vulgaris?
    • aggressive immunosuppression
    • prednisolone
    • mycophenolate
  26. what are the 2 main complications of pemphigus vulgarise?
    • overwhelming sepsis as massive immunosuppression
    • drug side effects
  27. what age does pemphigus vulgaris affect?
    middle aged
  28. which sign is positive in pemphigus vulgaris and what does this mean?
    • Nikolsky's sign
    • bullae are easily broken
    • even rubbing apparently normal skin causes the superficial epidermis to slough off
  29. where are the autoantibodies attacking in pemphigus?
  30. where are the autoantibodies attacking in pemphigoid?
  31. if a patient presents with diarrhoea, weight loss and a vesicular rash on extensors what is it?
    • dermatitis herpetiformis
    • associated with coeliac disease - gluten sensitive enteropathy
  32. what is the main symptom of dermatitis herpetiformis?
  33. what age and gender and race does dermatitis herpetiformis affect mostly?
    • early adult life 20's
    • m>f 2:1
    • caucasians
  34. how would you describe the rash of dermatitis herpetiformis - inc morphology and distribution
    • papules and vesicles
    • excoriated
    • symmetrical
    • extensors - elbow, knee, buttocks, scalp
  35. how do you diagnose dermatitis herpetiformis?
    • histology
    • immunofluorescence
    • IgA seen in dermal papillae
  36. what is Rx of dermatitis herpetiformis?
    • gluten free diet
    • +/- dapsone
  37. if you see targetoid blisters - what is that?
    erythema multiforme
  38. what are causes of erythema multiform?
    • infection - herpes, mycoplasma
    • drugs: anticonvulsants - phenytoin, antibiotics - sulphonamides, NSAIDs
  39. what is the difference between EM and steven johnsons?
    in stephen johnsons: mucous membrane involvement - eye and mouth
  40. what is the worst part of the spectrum of erythema multiform?
    • toxic epidermal necrolysis
    • dermatological emergency
  41. what is the usual cause of TEN?
    drug induced
  42. how would you describe TEN?
    • blistering
    • haemorrhage
    • necrosis - purpura
  43. what is the Rx of TEN?
    • transfer to burns unit or ITU
    • stop implicated drug
    • fluid balance
    • nutrition
    • temperature
    • prevent infection
    • ivIG
  44. what causes porphyria cutanea tarda?
    deficiency of enzyme needed in HAEM synthesis
  45. what are symptoms of porphyria cutanea tarda?
    • photosensitivity's in the form of blisters and erosions on sun exposed skin areas
    • hyperpigmentation of skin
    • hypertrichosis especially on upper cheeks
  46. what other medical problem is porphyria cutanea tarda associated with?
    liver problems
  47. what are Ix for porphyria cutanea tarda?
    urine, blood, faeces analysis for porphyrins
  48. what is Rx of porphyria cutanea tarda?
    • avoid alcohol, iron supplements, excess sun exposure
    • low dose antimalarials
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