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32 Cards in this Set
- Front
- Back
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What is a blister? (explain the MOA)
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Blister is a bubble like space which arises when there is a separation of the the different layers of skin
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Pemphigus Vulgaris
Pathogenesis? (MOA) |
Autoimmune destruction of desmosomes between keratinocytes
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What kind of antibodies are made in Pemphigus vulgaris? Against what structure in the skin?
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IgG antibody against the desmosomes (desmoglein = the specific name)
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What type of hypersensitivty reaction is pemphigus vulgaris?
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Type II
(AB mediated cytotoxic via membrane attack complex) |
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What is the typical involvment (body part) in pemphigus vulgaris?**
What kind of lesions are formed (note: use derm terminology) |
Skin and oral mucosa
Bullae (>1cm and fluid filled) |
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What are keratinocytes connected by?
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Desmosomes
(AB formed against that in Pemphigus vulgaris) |
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What is Acantholysis?
In what disease does this happen? |
Seperation b/w cells (keratinocytes) b/c desmosomes destroyed
happens in pemphigus vulgaris |
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What layer of the epidermis is the separation formed in pemphigus vulgaris?
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Since it is the separation b/w keratinocytes, it seperates the basal layer from the rest of the epidermis
The basal layer keratinocytes are attached to basement membrane via hemidesmosomes (NOT desmosomes) |
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Nikolsky sign?
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The thin walled bullae rupture easily.
When you touch them, their skin easily scrapes off Pemphigus Vulgaris |
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What disease is this?
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This is pemphigus vulgaris b/c the basal layer still attached
Tombstone appearance (basal layer) |
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Immunofluorescence highlighting IgG. What kind of pattern is this?
Associated with what disease? |
Fishnet pattern
Immunofluorescence highlights IgG surrounding the keratinocytes in a fishnet pattern Pemphigus vulgaris |
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Bullous Pemphigoid
MOA of disease |
autoimmune destruction of hemidesmosomes b/w basal cells and basement membrane
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Bullous pemphigoid
What kind of antibodies are produced? Against what? |
IgG antibody against basement membrane collagen
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What are the common locations to see blisters?
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Skin ONLY
(no oral; helps differentiate from pemphigus vulgaris) |
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How do you differentiate b/w Bullous pemphigoid and pemphigus vulgaris?
(clinically and histology) |
BP:
histology - subepidermis blister clinical - do not rupture easily (milder) PV: histology: suprabasal blister clinically: rupture easily (Nikolsky sign) |
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What is this?
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Bullous pemphigoid
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Immunofluorescence highlights IgG
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IgG along basement membrane
Linear pattern Bullous pemphigoid |
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24 yr old male pt. comes in with lesions on his forearm. When you touch them they don't rupture easily. What does he likely have?
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These are blisters (fluid filled; >1cm)
Bullous Pemphigoid |
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Dermatitis Herpetiformis
MOA of disease |
Autoimmune deposition of IgA at the tips of dermal papillae
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What is contained in the dermal papillae
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many things but blood vessels probably most vulnerable to injury
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What kind of skin lesions do you get with Dermatitis Herpetiformis
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vesicles (fluid filled <1cm) and bullae (fluid filled >1cm) that are grouped
ITHCY note: looks like herpes, hence the name |
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What is Dermatitis Herpetiformis associated with?****
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Strong associated with Celiac Disease
resolves with gluten free diet (both) |
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Dermatitis herpetiformis
grouped fluid filled vessicles/bullae Itchy |
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Erythema multiforme
MOA of disease |
hypersensitivty reaction characterized by TARGET rash and bullae
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Why do you get targetoid appearance in Erythema multiforme?
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Central epidermal necrosis leads to the center being white
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What is the most common associated with Erythema Multiforme?
Other associations? |
Most common: HSV infections
Others: Mycoplasma infection, drugs (eg. penicillin), autoimmune diseases, malignancy |
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Erythema multiforme
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Stevens-Johnson syndrome
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EM (target rash) WITH
-mucosa/lip involvment -Fever |
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Toxic epidermal necrolysis
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Severe form of Steven-johnson syndrome characterized by sloughing of skin, resembling a large burn.
Medical emergency |
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What is the toxic epidermal necrolysis most often due to?
What is it a severe form of? |
most often due to drugs
severe form of Steven Johnson syndrome |
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What are the common places to lesions for pemphigus vulgaris?**
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Skin and Oral mucosa bullae
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What is Dermatitis Herpetiformis assocaited with?**
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Celiac disease
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