Term
| Etiology of classifaction of blistering eruptions |
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Definition
| Friction, Burn, Congenital, Autoimmune, Toxin mediated, unknown etiology |
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Term
| Localization within the mucocutaneous integument classifcation of blsitering eruptions |
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Definition
| Intraepidermial, subepidermal, intradermal (urticarial) |
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Term
| Epidermal cells intercellular substance (ICS) |
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Definition
| Cells are held together by an extra-cellular matrix; desmosomes = intercellular bridges, within cells are filamentous structures = tonofilaments; tonofilaments are goruped into bundles = tonofibrils (run to desmosomes but do not pass beyond cell membrane) |
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Term
| Contact dermatitis characteristics |
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Definition
Allergic vs. irritant dermatitis
Allergens and strong irritants --> vesicles/bullae
Weaker irritant repeatedly applied --> dry, scaly eruption
(detergents irritant dermatitis, toxic injury to skin by a chemical, direct but non specific reaction, very common)
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Term
| Contact dermatitis definition |
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Definition
| An inflammatory reaction of skin, precipitated by exogenous chemicals, irritant vs allergic dermatitis: can not tell clinically, history or patch tests |
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Term
| Allergic contact cheilitis |
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Definition
| Rare compared to irritant dermatitis, T-cell mediated, type IV hypersensitivity, clinical disease occurs 24 to 48 hours after second exposure, precipitating contactant may be obvious |
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Term
| Irritant contact cheilitis |
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Definition
| Common, environmental factors sun, cold, and wind; lip licking, drooling and pooling of saliva; nonspecific inflammatory reaction, vesicles are rare, scaling common |
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Term
| Definition of irritant contact dermatitis |
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Definition
| Nonspecific inflammatory rxn, very common, toxic inury of skin, damage evident within hours with a strong irritant (vesicles or bullae); weaker irritants may require multiple applications and days (dry, scaly erythema) |
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Term
| Irritant cheilitis work up |
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Definition
| history (foods, lip care products, skin care topical medications; candy and gum, denture care, orthodontic appliances, and elastics); Physical exam, look for other diseases, medicaments; Rx: low balsam diet - avoid chocolate, liquors, ice cream, colas, spices, citrus products, strawberries, tomato products |
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Term
Allergic cheilitis work up
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Definition
| Perform patch tests and use tests; change or discontinue suspicious products (eliminate sodas candies and gums; change dental, ortho, athletic appliances); obtain material data sheets for suspected products i.e. braces and wires may have 50% nickel --> nickel allergy; look for non-nickel alternatives, remove offending appliances |
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Term
| Allergic contact dermatitis |
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Definition
| Configuration (angular corners, geometric outlines, and sharp margins) depends upon the nature of the exposure - linear streaks on extremities --> plants, patches on dorsal aspect of feet --> leather, round plaque on buttock --> nickel; "outside job" |
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Term
| Diagnosing allergic contact dermatitis |
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Definition
| Location helpful in predicting causative agent: scalp - hair dyes, permanents, shampoos; feet - allergens in shoes i.e. Rubber, chemicals and leather tanning agents; face - makeup, sunscreens, aerosols; extremities - plants |
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Term
| Laboratory and biopsy of allergic contact dermatitis |
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Definition
| No standard testing method available for diagnosing irritant contact dermatitis; patch tests may identify the causative agent in allergic contact dermatitis |
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Term
| THerapy for contact dermatitis |
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Definition
| Identifying culprit (history, physical, exam, patch testing); avoidance; steroids (topical vs. systemic, extent of involvement, other medical condition/extenuating factors) |
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Term
| Allergic contact dermatitis therapy |
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Definition
| Avoid precipitating agent, acute severe generalized contact dermatitis is treated w/ a short course of systemic steroids and wet dressings or baths; milder dermatitis responds to topical steroids and systemic antihistamines |
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Term
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Definition
- Supportive care: good lip care, moisturize, sunscreen, avoidance of lip licking, avoid irritants and allergens, vaseline or aquaphor
- Toothpastes: tom's of maine - unflavored homeopathic baking soda, baking soda, water and salt
- Meds: corticosteroids ointments, tacrolimus ointment, pimecrolimus ointment |
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Term
| Pemphigoid (bullous pemphigoid) |
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Definition
| Autoimmune disease, 60 to 80 years old; 33% w/ oral lesions; large, tense pruritic blisters; skin normal or erythematous, Negative Nikolsky sign |
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Term
| Pemphigoid (cicatricial pemphigoid) |
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Definition
| Skin heals without scarring, conjunctival scarring (ectropion, synechiae, blindness) |
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Term
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Definition
| Subepidermal blister, eosinophiles, lymphocytes |
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Term
| Diagnostic test for pemphigoid |
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Definition
| Direct immunofluorescence: use patient's skin; indirect immunofl: use patient's serum; circulating Ab's target 180 kd and 230 kd @ BMZ; linear IgG and C @ BMZ; Ab to hemidesmosome ag |
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Term
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Definition
| Prognosis is excellent, disease usually subside (months to years), high response to systemic steroids, tetracycline and niacinamide may allow administration of lower prednisone dose |
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Term
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Definition
| Family of chronic blistering disorders; acantholysis = intraepithelial split |
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Term
| Characteristics of pemphigus vulgaris |
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Definition
| World wide distribution, a condition of middle age M=F, <20 F>M; Ashkenazi Jews, Japanese HLA-A10; circulating ab's fix to intercellular substance (desmoglein 3) |
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Term
| Clinical of pemphigus vulgaris |
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Definition
| Flaccid bullae and superficial erosions; >50% present with oral erosions; mucous membranes (oral, vulva, conjunctiva, larynx; intact bullae rare; may precede skin by months), Nikolsky sign is positive "normal" skin can be dislodged by sliding pressure |
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Term
| Histology of pemphigus vulgaris |
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Definition
| intraepidermal acantholysis; adherence of basal cells to dermis --> tombstones |
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Term
| Diagnosis of pemphigus vulgaris |
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Definition
| Immunofluorescence: intraepidermal staining; IgG and/or C3 deposited in intercellular spaces between keratinocytes |
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Term
| Correlation with disease of pemphigus vulgaris |
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Definition
| Antibody titer correlate w/ disease activity; differential diagnosis. other bullous disorders such as pemphigoid, bullous drug eruptinos, and impetigo |
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Term
| Treating pemphigus vulgaris |
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Definition
Prior to initiation of steroids --> uniformly fatal, follow antibody titers - pre, therapy, taper; prednisone 1 mg/kd/day; may go up to 2 mg
Steroid sparing agents limit side effects no scar but hyperpigementation is common |
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Term
| Erythema Multiforme (EM) definition |
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Definition
| Immunologic reaction, triggered by circulating immune complexes, innumerable etiologic agents implicated (drugs; infection; 50% no identifiable etiology) |
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Term
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Definition
| Localized eruption, target lesions, erythematous, papules and plaques, extremitis, symmetric, excellent prognosis |
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Term
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Definition
| Widespread, blisters frequent, mucous membrane characteristics (oral mucosa, lips, conjunctivae); patients looka nd feel systemically ill (fever and prostraction); high mortality |
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Term
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Definition
| Three zones of color: central dark area or blister, pale edematous zone, peripheral rim of erythematous zone, pale peripheral rim |
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Term
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Definition
Chest x-ray to screen for pneumonia; tzanck vesicular lesions; biopsy basal cell vacuolization, dyskeratosis, and mild superficial perivascular infiltrate.
Differential diagnosis. Urticaria, viral exanthems, blistering diseases such as staphylococcal scalded skin syndrome, pemphigus and pemphigoid |
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Term
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Definition
| Symptomatic treatment for mild form, treat precipitating cause, support measures; use of systemic steroids controversial, IVIG may stop progression |
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Term
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Definition
| Circulating immune complexes, antigen derived from implicated drug or infectious agent; evidence: IgM around blood vessels, immune complexes (herpes ag) in serum in patients with herpes-triggered recurrent EM but not in pts w/ recurrent herpes simplex alone or in pts with drug-induced EM; detection of herpes ag by PCR |
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Term
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Definition
| At bed-side, cytology - Tzanck cells; limited utility + for HSV and VZV fresh vesicles ; stain specimen; examin microscopically; lab studies direct fluorescent ab; culture 48-72 hrs |
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