Master the board step 3

Section 3
Dermatology
Bullous and Blistering Diseases
Pemphigus Vulgaris
This is an autoimmune disease of unclear etiology in which the body becomes,
essentially, allergic to its own skin. Antibodies are produced against antigens
in the intercellular spaces of the epidermal cells. Its causes are as follows:
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Idiopathic
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ACE inhibitors
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Penicillamine
Pemphigus vulgaris acts like a burn, because the bullae occur from destruction
within the epidermis and so are relatively thin and fragile.
Nikolsky’s sign is present: Nikolsky’s sign is the easy removal of skin by just a
little pressure, with the examiner’s finger pulling it off like a sheet. Note that
Nikolsky’s sign is present in pemphigus vulgaris, staphylococcal scalded skin
syndrome, and toxic epidermal necrolysis.
The lesions of pemphigus vulgaris are painful, not pruritic.
Diagnostic Testing
The most accurate diagnostic test is a biopsy of the skin.
Treatment
Treatment is as follows:
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Use glucocorticoids, such as prednisone.
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When steroids are ineffective, use the following:
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Azathioprine
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