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Bullous pemphigoid

-An autoimmune skin disorder w/ chronic pruritic bullous eruptions.
-Usu. in elderly patients

•S/Sxs: tense bullae, negative Nikolsky's sign (no shearing w/ pressure), may see urticaria or dusky annular lesions. Pruritis common. Oral lesions in 1/3.
•Diagnosis: H & P, skin biopsy, serum antibody titers
•DDX: pemphigus, dermatitis herpetiformis, erythema multiforme, drug eruptions

Dermatitis herpetiformis

-Autoimmune, chronic, recurring, symmetrical groups of intensely itchy, inflamed vesicles, papules and hives.
-gradual onset, Pt's usually appear in 20s-40s. 75-90% of pts. have CELIAC SPRUE.
•S/Sxs: Burning, stinging and itching that lasts for weeks to years on symmetrical EXTENSOR aspects (elbows, knees, occiput, sacrum).
•Diagnosis: H & P, skin biopsy of lesion and adjacent normal skin, showing IgA deposition in the papillar tips
•DDX: pemphigus vulgaris, bullous pemphigoid, dermatitis, herpes

Pemphigus vulgaris

-Uncommon, potentially fatal (from secondary infection), autoimmune blistering disease.
-Usually affects middle-aged & elderly ppl.
-Autoantibodies to epidermal desmosomes.
•S/Sxs: Mouth lesions may appear first. FLACCID bullae, various sizes, on the skin and mucus membranes. Skin shears off, leaving painful erosions. Locations: mouth, groin, scalp, face, axilla and umbilicus.
•Hospitalization almost universally required
•Diagnosis: By H & P and biopsy. POSITIVE NIKOLSKY's sign (shearing w/ pressure).
•DDX: Herpes simplex and zoster, bullous pemphigoid, canker sores

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