DERMATOSA VESIKO BULOSA

(Chronic vesico bullous)

CLASSIFICATION OF CVB
1. EPIDERMAL BLISTER
Pemphigus vulgaris
2. SUB-EPIDERMAL BLISTER
Bullous pemphygoid
3. INFRA-BASAL BLISTER
Dermatitis herpetiformis
PEMPHIGUS VULGARIS
Definition :
A disease of skin and mucous membrane that characterized by
chronic intraepidermal blister
On normal to erythematous skin
EPIDEMIOLOGY
Male = female, age : 50-60 years

Children are rare
ETIOLOGY
Certainty?
Drugs : penicillamine, sulfhidryl,
captopril,penicillin,rifampicin,etc.

CLINICAL FEATURES
flaccid vesicles or blister, fragile, erosion
hyperpigmentation and crusts
oral mucous membrane, esofagus with
swallowing disorder
Predilection : oral mucous membrane,
scalp, trunk, buttock, face, neck, armpit,
genital
PATHOGENESIS
auto-immune mechanism, acantholysis, intra epidermal

Antibody binding surface cell glycoprotein

plasmin and enzyme activity

Intercellular cement damage
SUPPORTING EXAMINATION
Nikolskys sign
Asboe-Hansens sign (spread phenomen)
Histopathology :
- acantholytic cells (Tzancks method)
- intra epidermal blister
- IgG dermoepidermal junction
(immunofluorescence)
TREATMENT
Severe, hospitalized
Topical and systemic therapy,
corticosteroid, immunosupressive agent,
cyclophosphamide
PROGNOSIS
Quo ad vitam, high mortality rate
Quo ad functionam, dubia
Quo ad sanationam, dubia
PEMPHYGOID BULLOSA
DEFINITION :
tense vesicles/blister,chronic,erythematous base
ETIOLOGY :
Certainty ?
Auto-immune (concomittant with other
autoimmune diseases,e.g. rheumatoid,
myastenia gravis)
EPIDEMIOLOGY :
All ages, especially elderly
Male = female


PATHOGENESIS
Antigen Complex + Antibodies (IgG,C3,IgM)


Lamina lucida (BMZ)



Inflammation, tissues damage

CLINICAL FEATURES
Good general state, mucous membrane (20%)
Predilection : armpit, flexor forearm, groin
Vesicles,blister,erosion
Supporting Examination
Histopathology, sub epidermal blister
IgG,C3 sedimentation dermoepidermal junction
Treatment
Topical dermatotherapy
Systemic :
Corticosteroid
Dapsone
Sulphapyrimidine
DERMATITIS HERPETIFORMIS
(Duhrings disease)
DEFINITION
Clustered vesico-bullous, erythematous base,
severe itching
EPIDEMIOLOGY
- Male = female
- Age of 20-40 years
- Children : rare
ETIOLOGY ?
CLINICAL FEATURES
Vesicle-blister,tense, content clear fluid
turbid, subjective severe itching

predilection: scalp, posterior neck, posterior armpit,
sacral,extensor forearm,knee,and elbow

PATHOGENESIS
Disorder of jejunum mucosa
Gluten + IgA inflammatory response
skin damage
SUPPORTING EXAMINATION :
- KI test
-Histopathology:
subepidermal blister, eosinophilic infiltration
-Immunofluorescence, IgA & C3 deposits in dermal papillary

TREATMENT :
- Gluten-free diet
-Topical dermato therapy
-Systemic dermatotherapy: DDS, sulfapyridine
PROGNOSIS :
- Quo ad vitam and functionam ad bonam
-Quo ad sanationam dubia (recidive chronic)