Master the board step 3

Master the Boards: USMLE Step 3
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Mycophenolate
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Cyclophosphamide
Bullous Pemphigoid
Pemphigoid can be drug induced by sulfa drugs and others.
The fracture of the skin causing the blisters is relatively deep, and the bullae
are thicker walled and much less likely to rupture than the bullae of
pemphigus vulgaris. Oral lesions are rare. Because the bullae are tense and
intact, the skin is better protected. There is no dressing for skin as good as the
skin. Hence, there is much less fluid loss and infection is much less likely as
compared with pemphigus vulgaris. Mortality is much less likely in bullous
pemphigoid.
Diagnostic Testing
Test for bullous pemphigoid by performing a biopsy with immunofluorescent
antibodies.
Treatment
Treatment is as follows:
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Use systemic steroids, such as prednisone.
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Alternatives to steroids:
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Tetracycline
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Erythromycin with nicotinamide
The following table compares pemphigus vulgaris and bullous pemphigoid.
Pemphigus Vulgaris
Bullous Pemphigoid
Age range 30s and 40s 70s and 80s
Severity Life-threatening Resolves
Bullae Thin and fragile Thick and intact
Mouth involved Yes No
Other features
Nikolsky’s sign
Pemphigus Foliaceus
This blistering disease is associated with other autoimmune diseases, or it
can be drug induced by ACE inhibitors or NSAIDs. Foliaceus is much more
superficial than pemphigus vulgaris and bullous pemphigoid, and intact bullae
are not seen because they break so easily. There are no oral lesions.
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