Ichy blisters all over the body.

40-year-old female, without comorbidities presenting with these itchy blisters all over the body for 3 months. Initially, it started as a single blister only. When they heal, they form dark crust. The mouth is also affected. Patient was prescribed flucloxacillin for 1 week without any improvement following which she was prescribed dalacin capsules with chlorhexidine wash for another week. No improvement as well. No fever. How do we tackle this case and what are the treatment options?




Tnx Dr Shivraj Agarwal sir

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Itchy rash likely to be bullous pemphigoid although unlikely age group for this disorder.hand and mouth lesions look like herpetic Whitlow and stomatitis although abdominal rash cannot be explained by a herpes diagnosis.

Bullious pemphigoid. Bullous pemphigoid occurs when your immune system attacks a thin layer of tissue below your outer layer of skin. The reason for this abnormal immune response is unknown, although it sometimes can be triggered by taking certain medications. There are 2 main components to the pathophysiology of BP: immunologic and inflammatory. The immunologic elements comprise autoantibodies against 2 parts of the basal keratinocyte hemidesmosomal proteins BP antigen 230 (BPAG1) and BP antigen 180 (BPAG2 or type XVII collagen.

Bullous lesions seen all over with blackening of skin D/d bullous impetigo Bullous pemphigus

Thanx dr Kute Ankush

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Pemphigus vulgaris is more likely diagnosis than bullous pemphigoid Pemphigus is characterized by autoantibodies against the connections between epidermal cells. In bullous pemphigoid, patients have autoantibodies against the basement membrane of the epidermis. Thus the bullae in bullous pemphigoid are actually subepidermal, so in bullous pemphigoid, you’ll see lots of intact, tense bullae, Where as in pemphigus vulgaris there are lots of ruptured bullae covered with scabs. In this case, there are many ruptured bullae, therefore it is likely to be pemphigus vulgaris. It is a chronic disease and steroids are main Stay of treatment

Looking like Bullous pemphigoid Steroids orally and locally ointment Blister wall for histopathology examination Adv blood sugar and Torch test

Bullous disease under investigation. Adv: Histopathological examination with Immunofluorescence. Blood for CBC with Platelet, Viral Serology, FBG PPBG Hba1c.

Thank you Dr Jain and Dr Sahana Sir

Bullous Pemphigoid Needs further investigation and evaluation to conclude and treatment plan.

Thanks Dr Kute Ankush

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Bullous pemphigoid Lizolid Antoxid HC Cream. Inflobact- 4G Tab. Zamflex

Bullouss eruptions Bullous pemphigoid Rule out diabetes. Steroid local application Steroids orally. Dapsone orally.

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