55 yr old female presents with soft bullous lesion as shown in image which burst and form a painful lesions which r present on whole body..she also have mouth ulcer and inable to feed..no h/o fever.. no DM BP- 90 /60..non smoker.. diagnosis and management

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IT'S A CASE OF.. D/D.. * BULLOUS PEMPHIGOID.. * BULLOUS IMPETIGO.. * EPIDERMOLYSIS BULLOSA.. * EM.. BETTER TO DO.. TISSUE HISTOPATHOLOGICAL STUDY & OTHER INVESTIGATIONS AS NEEDED

Tnx Dr Dinesh Gupta
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Provisional clinical diagnosis: 1.    Pemphigus vulgaris 2.    Erythema multiforme 3.    ??? History desire: Any drugs prior to rash Desire clinical finding: Nikolshky sign: Positive favors diagnosis of Pemphigus vulgaris                                                                 Negative favors diagnosis of Erythema multiforme Primary investigation: Tzanck smear •    Acantholytic cells will suggest pemphigus •    Necrotic epidermal cells will suggest EM •    Infiltrate Skin biopsy from early lesion- small vesicle IF and other investigations if needed.

Bullous EM Major / Pemphigus / Pemphigoid / Paraneoplastic Pemphigus (?)

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Start iv Augmenting 1.2 g iv TDs Inj Hydrocortisone 100 mg TDS Topical steroids Inj Avil BD Ini Esomepr BD Go for Expert consultation Immune deficiency , Diabetes to be rule out yet

Bullous impetigo

Bullous pemphigoid /Bullous Impetigo/ Erythema Multiforme?/ Drugs induced ?.

? Bullous Pemphigoid

Pemphigus bulloid, Steroids orally topically antihistomonics Antioxidants

BULLOUS ERYTHEMA MULTIFORME DD BULLOUS . PEMPHIIGOID

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