Difference between revisions of "Bullous diseases"
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'''Bullous | '''Bullous diseases''' are a subset of the large [[inflammatory skin diseases]] category. Dermatopathologists help diagnose it. | ||
An introduction to skin pathology is in the ''[[dermatopathology]]'' article. An introduction to inflammatory skin lesions in the ''[[non-malignant skin disease]]'' article. | An introduction to skin pathology is in the ''[[dermatopathology]]'' article. An introduction to inflammatory skin lesions in the ''[[non-malignant skin disease]]'' article. | ||
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DDx of bullous disease:<ref>TN07 D21-3.</ref> | DDx of bullous disease:<ref>TN07 D21-3.</ref> | ||
*Bullous pemphigoid. | *Bullous pemphigoid. | ||
*Pemphigus vulgaris. | *[[Pemphigus vulgaris]]. | ||
*Porphyria cutanea tarda. | *[[Porphyria cutanea tarda]]. | ||
*Dermatitis herpetiformis. | *[[Dermatitis herpetiformis]]. | ||
*Epidermolysis bullosa. | *Epidermolysis bullosa. | ||
| Line 13: | Line 13: | ||
*Pemphigus foliaceus. | *Pemphigus foliaceus. | ||
*Pemphigus vegetans. | *Pemphigus vegetans. | ||
*Grover's disease (transient acantholytic dermatosis). | *[[Grover's disease]] (transient acantholytic dermatosis). | ||
*Darier's disease. | *[[Darier's disease]]. | ||
*Hailey-Hailey disease. | *[[Hailey-Hailey disease]]. | ||
==Bullous pemphigoid== | ==Bullous pemphigoid== | ||
Revision as of 03:20, 20 September 2011
Bullous diseases are a subset of the large inflammatory skin diseases category. Dermatopathologists help diagnose it.
An introduction to skin pathology is in the dermatopathology article. An introduction to inflammatory skin lesions in the non-malignant skin disease article.
DDx of bullous disease:[1]
- Bullous pemphigoid.
- Pemphigus vulgaris.
- Porphyria cutanea tarda.
- Dermatitis herpetiformis.
- Epidermolysis bullosa.
Subcorneal bullous disease:
- Pemphigus foliaceus.
- Pemphigus vegetans.
- Grover's disease (transient acantholytic dermatosis).
- Darier's disease.
- Hailey-Hailey disease.
Bullous pemphigoid
General
- Less serious than pemphigus vulgaris.
Epidemiology:
- Old people (60-80 year olds).
Clinical
- Extreme pruritis.
Etiology:
- Antibodies to BPAG2.
Microscopic
Features:[2]
- Subepidermal blisters.
- +/-Lymphocytes.
- +/-Eosinophils.
- +/-Neutrophils.
Notes:
- Epidermis not affect, i.e. non-acantholytic.
- Linear Ig deposits along basement membrane.
Images:
DDx:
- Bullous lupus.
Pemphigus vulgaris
- AKA pemphigus.
General
Classic presentation:
- Mouth lesions.
- Non-pruritic.
Treatment:
- Prednisone then steroid sparing agent.
Epidemiology:
- Associated with thymoma, myasthenia gravis, malignancy & D-penicillamine (used to Tx Wilson's disease).
- Middle age.
Microscopic
Features:[5]
- Suprabasilar blistering.
DDx: Hailey-Hailey disease.
Images:
Notes:
- Desmoglein 1, desmoglein 3 - abnormal.
Familial benign pemphigus
- AKA Hailey-Hailey disease. Was described by two brothers - that's why it is Hailey-Hailey.[7]
General
- Genetic - autosomal dominant with incomplete penetration.[7]
- Desmosomal defect - due to mutation in the gene ATP2C1.[7]
Clinical:
- Chest.
- Intertriginous regions. (???)
- Typically presents individual in their 30s and 40s.[7]
Microscopic
Features:
- Suprabasilar blistering.
- Acanthosis (thick epidermis).
Notes:
- Hair folicles spared.
DDx:
Dermatitis herpetiformis
General
- Associated with celiac sprue.
Clinical:
- Pruritis - intense.
Microscopic
Features:[8]
- Subepidermal blistering.
- Clusters of neurophils (microabscesses) - at tips of dermal papillae - key feature.
- Basal cell injury (vacuolization).
Notes:
- Immunofluorescence - IgA deposits at dermal papillae.
Images:
Porphyria cutanea tarda
General
Etiology:
- Genetic, autosomal dominant.
Treatment:
- D/C aggravating substances (see below) - phlebotomy, hydroxychloroquine if phlebotomy contraindicated.
Note:
- Fits into a larger category of porphyria.
Associations
Medications/substances:
Non-infection chronic conditions:
- DM.
Infections:
Gross
- In photoexposed areas subjected to trauma.
Microscopic
Features:[10]
- Subepidermal vesicles.
- Thickening of superficial dermal blood vessels.
Images:
Epidermolysis bullosa
- Inherited, bullae & erosions from slight mechanical trauma.
Grover disease
- AKA transient acantholytic dermatosis.
General
- Genetic. (???)
Microscopic
Features:[11]
- Subcorneal bullous disease.
- Acanthosis.
- Dyskeratosis.
See also
References
- ↑ TN07 D21-3.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1195. ISBN 978-1416031215.
- ↑ URL: http://dermatology.cdlib.org/94/NYU/Feb2002/8.html. Accessed on: 20 March 2011.
- ↑ URL: http://missinglink.ucsf.edu/lm/DermatologyGlossary/bullous_pemphigoid.html. Accessed on: 20 March 2011.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1193. ISBN 978-1416031215.
- ↑ URL: http://www.dermpedia.org/baby-dermpedia-for-beginners/pemphigus-vulgaris. Accessed on: 20 March 2011.
- ↑ 7.0 7.1 7.2 7.3 URL: http://emedicine.medscape.com/article/1063224-overview. Accessed on: 9 September 2011.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1196. ISBN 978-1416031215.
- ↑ URL: http://dermatology.cdlib.org/94/NYU/Nov2001/9.html. Accessed on: 21 March 2011.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1197. ISBN 978-1416031215.
- ↑ S. Sade. 8 September 2011.