Bullous diseases

Bullous disease happens. Dermatopathologists help diagnose it.

DDx of bullous disease:

• Bullous pemphigoid.
• Pemphigus vulgaris.
• Porphyria cutanea tarda.
• Dermatitis herpetiformis.
• Epidermolysis bullosa.

Bullous pemphigoid

Epidemiology

• Old people (60-80 year olds).

Pemphigus vulgaris

Classic presentation

• Mouth lesions.
• Non-pruritic.

Treatment

• Prednisone then steroid sparing agent.

Epidemiology

• Assoc. with thymoma, myasthenia gravis, malignancy & D-penicillamine (for Wilson's disease).
• Middle age.

DDx: Hailey-Hailey disease.

Dermatitis herpetiformis

Assoc. with celiac sprue.

Porphyria cutanea tarda

Etiology

• Genetic, autosomal dominant.

Appearance

• Vesicles/bullae in photoexposed areas subjected to trauma.

Associations

Medications/Substances:

• EtOH, Rx (estrogen, NSAIDs).

Non-infection chronic conditions:

• DM.

Infections:

• HIV, hepatitis C.

Treatment

• d/c aggravating substances (listed above), phlebotomy, hydroxychloroquine if phlebotomy contraindicated.

Epidermolysis bullosa

• Inherited, bullae & erosions from slight mechanical trauma.

See also

• Non-malignant skin disease.
• Dermatopathology introduction.