DERMATOSA VESIKO BULOSA

(Chronic vesico bullous)

CLASSIFICATION OF CVB

1. EPIDERMAL BLISTER

– Pemphigus vulgaris

2. SUB-EPIDERMAL BLISTER

– Bullous pemphygoid

3. INFRA-BASAL BLISTER

– Dermatitis herpetiformis

PEMPHIGUS VULGARIS

Definition :

A disease of skin and mucous membrane that characterized by chronic intraepidermal blister

On normal to erythematous skin

EPIDEMIOLOGY

• Male = female, age : 50-60 years

• Children are rare

ETIOLOGY• Certainty?

• Drugs : penicillamine, sulfhidryl,

captopril,penicillin,rifampicin,etc.

CLINICAL FEATURES

flaccid vesicles or blister, fragile, erosion

hyperpigmentation and crustsoral mucous membrane, esofagus with

swallowing disorderPredilection : oral mucous membrane,

scalp, trunk, buttock, face, neck, armpit,

genital

PATHOGENESIS

auto-immune mechanism, acantholysis, intra epidermal

Antibody binding surface cell glycoprotein

plasmin and enzyme activity

Intercellular cement damage

SUPPORTING EXAMINATION

Nikolsky’s signAsboe-Hansen’s sign (“spread phenomen”)Histopathology :-acantholytic cells (Tzanck’s method)-intra epidermal blister-IgG dermoepidermal junction

(immunofluorescence)

TREATMENT Severe, hospitalized Topical and systemic therapy,

corticosteroid, immunosupressive agent,

cyclophosphamide

PROGNOSIS• Quo ad vitam, high mortality rate

• Quo ad functionam, dubia

• Quo ad sanationam, dubia

PEMPHYGOID BULLOSADEFINITION :tense vesicles/blister,chronic,erythematous baseETIOLOGY :

Certainty ? Auto-immune (concomittant with other autoimmune diseases,e.g. rheumatoid, myastenia gravis)

EPIDEMIOLOGY : All ages, especially elderly Male = female

PATHOGENESIS

Antigen Complex + Antibodies (IgG,C3,IgM)

Lamina lucida (BMZ)

Inflammation, tissues damage

CLINICAL FEATURES Good general state, mucous membrane (20%) Predilection : armpit, flexor forearm, groin Vesicles,blister,erosion

Supporting Examination Histopathology, sub epidermal blister IgG,C3 sedimentation dermoepidermal junction

Treatment Topical dermatotherapy Systemic :

CorticosteroidDapsoneSulphapyrimidine

DERMATITIS HERPETIFORMIS(Duhring’s disease)

DEFINITION

Clustered vesico-bullous, erythematous base,

severe itching EPIDEMIOLOGY

- Male = female

- Age of 20-40 years

- Children : rare

• ETIOLOGY ?

• CLINICAL FEATURES

Vesicle-blister,tense, content clear fluid

turbid, subjective severe itching

predilection: scalp, posterior neck, posterior armpit, sacral,extensor forearm,knee,and elbow

• PATHOGENESIS

Disorder of jejunum mucosaGluten + IgA inflammatory response skin damage

SUPPORTING EXAMINATION :- KI test-Histopathology:

subepidermal blister, eosinophilic infiltration-Immunofluorescence, IgA & C3 deposits in dermal papillary

TREATMENT :

- Gluten-free diet-Topical dermato therapy-Systemic dermatotherapy: DDS, sulfapyridine

PROGNOSIS :

- Quo ad vitam and functionam ad bonam-Quo ad sanationam dubia (recidive chronic)