Notes on Bullous Dermatoses

Bullous Dermatoses

  • Diverse group of skin diseases characterized by the formation of blisters on the skin and mucous membranes.

Classification of Bullous Dermatoses

  • Pemphigus:
    • True Pemphigus
    • Pemphigus vulgaris
    • Vegetative pemphigus
    • Pemphigus foliage
    • Erythematous pemphigus
    • Brazilian pemphigus
  • Pemphgoid:
    • Bullous pemphigoid
    • Scarring pemphigoid
  • Herpetiform Dermatoses:
    • Herpetiform dermatosis of Dühring
    • Herpes of pregnant women
    • Subcorneal pustulosis
  • Familial Benign Pemphigus:
    • Hailey-Hailey disease
  • Transient Acantholytic Dermatosis:
    • Grover's disease

Pemphigus

  • More common in women, especially in married individuals after age 50.
  • Characterized by long-term course and the development of blisters that may lead to general health decline.
  • Blisters rupture easily, leading to painful erosions.
Nikolsky Sign
  • Erosion occurs when lateral pressure is applied to normal skin near lesions.

Diagnosis

  • Monomorphic rashes of blisters on unchanged skin or mucous membranes.
  • Acantholytic cells detected in smears.
  • Histological examination reveals intraepidermal blisters.
  • IgG complexes found in the epidermis.
  • Circulating antibodies detected using indirect immunofluorescence.

Differential Diagnosis

  • Other pemphigus variations, bullous pemphigoid, dermatitis herpetiformis, and various infections.

Treatment

  • Corticosteroids, immunosuppressive agents, plasmapheresis, antibiotics, and vitamins.

Bullous Pemphigoid

  • Typically a benign disease with blisters mainly affecting the elderly.
  • Characterized by itchy blistering, primarily on the skin (not mucous membranes), and a negative Nikolsky sign.
  • Skin biopsies show subepidermal blisters and linear IgG and C3 deposits on immunofluorescence.

Scarring Pemphigoid

  • Primarily affects mucous membranes, notably the conjunctiva and oral cavity.
  • Requires corticosteroid treatment and sometimes cytotoxic agents.

Dermatitis Herpetiformis

  • Intensely itchy vesicular eruption; often symmetrical on extensor surfaces.
  • Associated with gluten-sensitive enteropathy.
  • Diagnosis made via IgA deposits and responsiveness to dapsone.

Treatment for Dermatitis Herpetiformis

  • Dapsone therapy combined with a gluten-free diet for effective management.