NE
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An 82-year-old woman comes to your office with a complaint of blistering skin rash. She reports that the blisters started to develop approximately 3 months ago, and at that time a friend told her that it looked like “hives.” The blistering process has continued, however, and she now reports getting 2 or 3 new blisters every day. The blisters are widespread and most numerous on the flexural surfaces of the skin. They have not, however, appeared on the head, neck, and in the mouth. You order laboratory studies and perform a punch biopsy of a skin lesion. The results of these tests are as follows:
Which of the following is the most appropriate therapy for this patient?
A. Methotrexate
B. Oral prednisone
C. Oral prednisone and plasmapheresis
D. Tetracycline
E. Topical steroids
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| ssrpk
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where are the results?
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| dr in trouble
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where r the results??/
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| NE
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Sorry!
The blood test are normal. Biopsy: IC in linear fashion at the dermal-epidermal junction.
( I can not copy-past the test results - I don't know why)
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| haduytu7
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This's a Bullous Pemphigoid. Treat with systemic glucocorticoids with or without azathioprine (Choice B).
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| doc_clotaire
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[left] Yes it is [/left]
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| NE
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sorry guys, I picked B too.But I was wrong, event the treat for bullous pemphigoid is prednisone.This is from kaplan qbank:
"This patient has bullous pemphigoid and topical steroids are the treatment of choice. Bullous pemphigoid is a relatively uncommon autoimmune disease of the skin in which IgG antibodies are directed at the dermal-epidermal junction. The disease tends to affect older individuals, who present much as the patient in this question: with tense blisters most prominent on flexural surfaces and sparing of the head, neck, and mouth. Peripheral blood eosinophilia sometimes is seen, and skin biopsy, as in this case, reveals IgG antibodies deposited at the dermal-epidermal junction. Although systemic steroids were long considered to be the treatment of bullous pemphigoid, research has shown that high-potency topical steroids (e.g., clobetasol) applied to the skin in large quantities results in better outcomes with fewer complications than do systemic steroids, even for severe disease. Indeed, in comparison with systemic steroids, topical steroids result in better control of disease with higher survival rates than treatment with systemic steroids. If a patient with bullous pemphigoid is able to comply with a topical steroid regimen, topical steroids are the treatment of choice "
And I looked up on the UpToDate and this is right despite what Kaplan book says!
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| doc_clotaire
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check it too from emedicine and it says :
A recent article from Europe provided evidence that strong topical corticosteroid treatment may achieve disease control while avoiding systemic adverse effects from systemic corticosteroids.
Thanks for sharing NE
Good question !
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| young_doc
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Topical steroids for mild cases. Oral steroids if severe.
Straight out of First Aid.
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