73 year old woman comes to clinic with intensely pruritic blistering lesions on the legs, and chest. The lesions are 1.5 cm in diameter with a red base. She has no previous history of these lesions.
An excisional biopsy of one of the lesions indicates bullous phemphigoid as a possible diagnosis.
What do you do now?
1. Treat with steroids
2. Treat with antibiotics
3. Biopsy normal skin
4. Order a sedimentation rate
Answer: Biopsy normal skin. The diagnosis of bullous phemphigoid is made with direct immunofluorescence studies of normal perilesional skin. The sample is generally sent in formalin, but you should ask your pathology department how they would prefer the sample.
Bullous phemphigoid is a chronic autoimmune skin disorder, affecting older people generally, with a duration of illness of 1 to 5 years. Occasionally (15-20%), there is mucosal involvement, and possibly ocular involvment.
Treatment includes topical and/or systemic steroids and possibly immunosuppressives or other anti-inflammatories.
Referral should be made to dermatology for skin lesions, ENT and a dentist for mucosal lesions and an ophthamologist for eye involvement and those requiring prolonged high-dose steroids.
is this a surgical problem?
ReplyDeleteHERBAL CURE FOR SHINGLES,WARTS AND HERPES,Hv/Aids 5 years ago I had warts, I was treated with some liquid applied to the warts they continued to grow and spread... The next 2 doctors did laser surgery to remove them. 1 year after the surgery, they grew back close to where the 1st ones were' so I was finally told it was SHINGLES. I have had it for a very long time, I contracted it from my cheated boyfriend and I found out he was also infected and I ended the relationship between us. The warts were so embarrassed because it started spreading all over. I have been dealing with these things for a very long time. The last treatment I took was About 2 years ago I applied for natural treatment from Dr. JAMES herbal cure, a week after applying the treatment all the warts were gone. It's now 2 years and some months I don't have a single wart or any symptoms of SHINGLES. wow"" it's great, Dr. JAMES has finally cured me. Anyone living with SHINGLES contact Dr. JAMES for natural treatments.his herbal medicine is easy to drink with no side effects. Dr.James has cure for diseases like Parkinson's disease,Schizophrenia,Lung Cancer,Breast Cancer,Colo-Rectal Cancer,Blood Cancer,Prostate Cancer ,Epilepsy Dupuytren's disease ,Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Sclerosis,Fibromyalgia,Fluoroquinolone Toxicity
ReplyDeleteSyndrome Fibrodysplasia Ossificans ProgresS sclerosis,Seizures,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases ,Copd,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis,Lupus,Cushing’s disease,Heart failure,Multiple Sclerosis,Hypertension,Lyme Disease,Blood Cancer,Brain Cancer,Breast Cancer,Lung Cancer,Kidney Cancer, HIV/AIDS, Herpes Virus,Hepatitis B, Liver Inflammatory,Diabetes,Fibroid. Contact Dr Jmaes who cured me on his Email [drjamesherbalmix@gmail.com
Hello, I have browsed most of your posts. This post is probably where I got the most useful information for my research. Thanks for posting, maybe we can see more on this. Are you aware of any other websites on this subject. skin cancer screening
ReplyDelete