28/F, a h/wife came with c/o prodromal symptoms of fever,malaise,loss of appetite,weakness x one week. Thereafter developed vesicles over the sole/feet ,palms and hands, followed by vesicles with ulcerations all over the trunk & abdomen and then in the mouth whereby she could not open and eat. Whole of palate, Cheeks and tongue has multiple mucosal ulcerations extending over the lips. No h/o of similar eruptions in the past, no familial h/o of such symptoms. Pts CBC is normal except for high Neutrophils and Hb of11.0gm%. HIV,RPR,HBs/HcAg nonreactive;ANA awaited. DD ?

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DD Pls Correct me.-- Fig 4&5....lesions have 2 zones of color The lesion’s core- vesicular, purpuric & that zone is surrounded by macular erythema....Typically of SJS Fif 1-3 Shows It's Pemphigus Major types of pemphigus: vulgaris (PV) foliaceous (PF), IgG autoantibodies Bullous pemphigoid (BP) -subepidermal blistering skin disorder -(unlike pemphigus) where the blistering is intra-epidermal   Pemphigus herpetiformis is also a varient Contrary to the other bullous disorders -there are no circulating autoantibodies -but have gluten-induced IgA autoantibodies Further- ANA Dermatology experts should through light...

Sir need ur advice for my case? Thanks and regards
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@Dr. Reema Sharma Fixed Drug Eruption Fixed drug eruptions (FDEs) characteristically recur in the same site or sites each time a particular drug is taken; with each exposure however, the number of involved sites may increase. Fixed drug eruption is a type of allergic reaction to a medicine. Usually just one drug is involved, although independent lesions (patches) from more than one drug have been described. Cross-sensitivity to related drugs may occur and there are occasional reports of recurrences at the same site induced by drugs that appear to be chemically unrelated. Sometimes the inducing drug may be re-administered without causing reappearance of thepatch(es) and there may be a refractory period during which no reaction can occur after the occurrence of FDE. How does FDE occur? Clearly some sort of allergy is involved but exactly how an FDE arises and in particular why just certain areas of skin are affected, has not been worked out. What does it look like? Fresh lesions are well defined, round or oval patches of redness and swelling of the skin, sometimes surmounted by a blister. This then fades to a purplish or brown colour. Fixed drug eruption The lesions usually develop within 30 minutes to 8 hours of taking the drug. They are sometimes solitary at first, but with repeated attacks new lesions may appear and existing ones may increase in size. Lesions are more common on the limbs than the trunk; the hands and feet, genitalia (glans penis) and perianal areas are favourite sites. Lesions may occur around the mouth or the eyes. The genitals or inside the mouth may be involved in association with skin lesions or on their own. As healing occurs, crusting and scaling are followed by a persistent dusky brown colour at the site. This may fade, but often persists between attacks. Pigmentation tends to be more extensive and pronounced in people with brown skins. Pigmentation from FDE fades when the causative drug is avoided. Non-pigmenting fixed eruptions have been reported with pseudoephedrine and piroxicam. Local or general symptoms accompanying an FDE are mild or absent. Drugs involved The number of drugs capable of causing fixed eruptions is large. Most are due to the following: Paracetamol /phenacetin and other pain killers (Panadol and many other makes)Tetracycline antibiotics; doxycycline (Doxine, Doxy, Doryx), minocycline (Minotabs, Minomycin), PanmycinSulphonamide antibiotics including cotrimoxazole (Bactrim, Septrin, Apo-Sulfatrim, Trimel, Trisul),sulfasalazine(Colizine, Salazopyrin)Acetylsalicylic acid/aspirin (Disprin and many other makes)Nonsteroidal anti-inflammatories (NSAIDs)including ibuprofen (Anafen, Brufen, Motrin, Nurofen, Panafen)Sedatives including barbiturates, benzodiazepines and chlordiazepoxide (Novapam)Hyoscine butylbromide (Buscopan, Scopoderm) seehalogenodermasDapsonePhenolphthalein (an old-fashioned laxative for constipation)Quinine (Q-200, Q-300, Quinoc), taken for cramps)Others.

Amazing explanation doc.. its really helpful
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-Pemphigus vulgaris (can check for nikolsky sign) EM(major) Epidermolysis Bullosa

Pemphigus vulgaris, bullous pemphigoid, S-J syndrome.

May be sj syndrome drug h/o rule out

Pemphigus vulgaris

Herpes infection

Herpes labialis

?pemphigus

Crustation of lips with target lesions... Suggest.. Erythema multiforme... Check for eye n lesions in other mucosal area.... D/d...SJS... pemphigus has vesicles n bulla on trunk... With positive nikolsys sign... Phemphigoid have bulla that r flaccid n don't rupture that easily...but I's seen in older males

Scrape n biopsy 4m fresh vesicle can be done..
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