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In sub-epidermal blistering disorders the most important are two to remember uh one is bolus pemphigoid and the other one is dermatitis hepatitis formus uh bolus pemphigoid uh uh is a condition that is chronic and autoimmune which features blistering and it is characterized by a circulating igg auto antibodies which are actually against the basement membrane
Proteins called hemidesmosomes uh uh no usually bp180 and bp230 as opposed to uh desmosomal uh uh antibodies in the cases of uh pemphigus garrus the activation of the complement cascade is also there by the igg on antibodies uh which results in basement membrane c3 deposits uh bullish pemphiguide is clinically milder than pamphigus vulgaris and it can spontaneously
Subside after months without any treatment and the factors which usually trigger it are furosemide uv light and radiation and neurodegenerative diseases like cbds and dementia and parkinson’s clinically the age group is usually elderly above 60 between 16 80 years of age very rare below that age group characterized by intact tense clear or hemorrhagic vesicles
Compared with the pemphigus vulgaris in which they were fragile and flaccid blisters uh and they’re also physical in bullying on the skin which are often accompanied by urticaria-like plaques which is not present in pemphigus diseases uh and pruritus again compare it with pam figures vulgaris and other spectrum disorders in which pain was the predominant uh uh
Symptom in this case paritis is it is painless bolus pemphigoid is painless uh bp generally lacks oral lesions while infant figures will garus 90 of the times of the mucosa is involved and it is ultimately negative uh nicole’s key because uh the the blisters are tense so uh they will not rupture easily as opposed to pemphigus vulgaris uh the diagnosis is usually
Clinical but you can do serological studies to detect circulating igg antibodies uh against hemidesmos bp180 and bp230 the most accurate test is uh skin biopsy however which shows sub epidermal blisters compared with pam figures in which it was intra epidermal which are often with an isophilic infiltrate when you do direct uh immunofluorescence you will find
Linear pattern in pamphlets also there is a linear pattern but there is no uh c3 deposition and there are no a circulating anti or antibodies of igg but here there is a linear pattern of c3 and igg deposition at the dej uh the treatment uh first line is potent topical steroids or oil steroids though it is not needed but if the provider is so severe you can give
Protein topical steroids and steroids orally uh second line which is basically uh uh a sparing therapy in which you give a thyroprint and methotrexate mycophenolate sacrofossomite or nicotinamide combined with tetracycline doxy minor and erythro just to prevent uh super infections this is all about bullets pamphlet way that you need to remember please subscribe
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Transcribed from video
Bullous Pemphigoid in less than 4 Minutes! By Audio Medicine Official
