VESICULOBULLOUS DISEASES

Disease
I. Pemphigous Vulgaris

Description
Chronic bullous
autoimmune disease

Epidemiology
Age of onset: 30-40 years
old

Prototype of
Pemphigous family

Equal incidence: M = F

Pathogenesis
Loss of normal cell to
cell adhesion in the
EPIDERMIS

History
No pruritus but with
burning and pain

Desmoglein 3 =
acantholysis

Physical Exam
Flaccid, easily ruptured
and weeping

Laboratory
Split epidermis [due to
lack of cell adhesion]

Extensive erosion [bleeds

easily]

Direct IF: IgG and C3

deposited in the lesional
and paralesional skin

Crust on the scalp

[+] Nikolsky Sign

II. Bullous Pemphigoid

Chronic bullous eruption

mostly in patients over
60 years of age

Age of onset: 60 years

old
Equal incidence: M = F

Interaction of Auto Ab
with bullous pemphigoid
Ag results to
complement activation
and attraction of
neutrophils and
eosinophils

Prodrome first then

evolves to bullae that may
appear as generalized
eruption

Bullae that contains

serous and hemorrhagic
fluid
Grouped in arciform and
serpigous pattern

Indirect IF: Auto Ab

directed against
Desmoglein 3
Subepidermal bullae
[Indian File pattern]
IF: IgG deposited along
the basement membrane

Bullae ruptures less easily

[-] Nikolsky Sign
Lower Legs [Most often
affected]

III. Herpes Viruses

Tx: acyclovir and

valacyclovir

A. Orolabial Herpes

95%: HSV 1
Herpetic
Gingivostomatitis

B. Herpetic Infection

Tzanck Smear: MNGC jig

saw nucleus
More common in
younger individuals

Grouped vesicles on an
erythematous base
Erosions, ulcers in mouth
with wide base

Recurrent Erythema
Multiforme Minor: HSV 1
Genital Herpes: HSV 2

IV. DDX for Vesicles and

Bullae
1. Bullous Empetigo

Intact or broken bullae

with honey colored crust

2. Vericella [VZV]

AKA Chicken Pox

Dew Drop on rose petal

3. Herpes Zoster

Reactivation of VZV on
the dorsal root ganglion
[Dermatomal]

Common nose and mouth

Grouped vesicles on any

erythematous base

PAPULOSQUAMOUS DISORDERS
Disease
I. Psoriasis

Description
Round, circumscribed,
erythematous, dry
scaling plaques of
various sizes
Covered by grayish white
or silvery white
imbricated and lamellar
scales

Epidemiology
Unknown
Equal frequency in both
sexes
8 y/old: children
22.5: adult
55: late

Psoriasis Ostraces
- Covered with outside
scales [outside of an
oyster]

Pathogenesis
3 Main Pathogenic
Feature:
1. Abnormal
Differentiation

History

Physical Exam

Laboratory

History

Physical Exam

Laboratory

2. Keratinocyte
Hyperproliferation
3. Inflammation
Accelerated
Epidermopoiesis

Koebners Phenomenon
- Appearance of lesions
of psoriasis at sites of
trivial injury
Woronoff ring
- Concentric blanching
erythema
Auspitzs Sign
- Pinpoint bleeding
Flexural/ Invasive
Psoriasis
- Salmon demarcated
plaques

Psoriasis
Disease
1. Psoriatic Arthritis
2. Guttate Psoriasis

3. Generalized Pustular
Psoriasis [Von
Zumbusch]

4. Psoriasis Vulgaris

II. Pityriasis Rosea

Description

Typical lesions are in

Water Drops Pattern
Abrupt eruption
following acute
inflammation
Sudden formation of lake
of pus, periungually
[palms, edge of psoriatric
plaques]
Acitracin: DOC [Never
give ORAL steroids]
Tx: Calcipotiene
Ointment
Unpredictable prognosis

Epidemiology
Incidence is greater in
persons with
Seronegative arthritis
Mostly < 30 years old

Unclear
May occur in infants

Pathogenesis

Recurrent because of
pharyngeal carriage of
Streptococcus

History of plaque
psoriasis and psoriatric
arthritis

Pruritus and intense

burning
Fever + fetid odor

Regular epidermal
hyperplasia with long,
test tube shaped rete
ridges
Granular layer is thin or
absent