Bullous pemphigoid: The Daily PANCE Blueprint
A 60-year-old female presents to your clinic complaining of blisters on her arm, lower legs, and palms for the past few weeks. On physical exam, you notice scattered large bullae that are tense and do not slough with tension. Which of the following is the first-line treatment for the most likely diagnosis?
A. High-dose topical steroids
B. Methotrexate
C. IV systemic steroids
D. Topical emollients
E. Surgery
Answer and topic summary
The answer is A. High-dose topical steroids
Bullous pemphigoid is the most common bullous autoimmune disease. It’s a type II hypersensitivity reaction. Clinical features include large blisters on erosive/red skin as well as pruritic lesions. Usually, patients will have urticarial lesions weeks before the blisters start occurring. It is uncommon to have oral involvement. The lesions are usually located on the palms, soles, lower legs, and groin. Tzanck and Nikolsky are negative. Diagnosis is made with a biopsy for histology and direct immunofluorescence testing. Direct immunofluorescence reveals linear deposition of IgG and C3 at the dermo-epidermal junction. The first line treatment is high-dose topical steroids. Other options include PO steroids or immunosuppressants.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Dermatology ⇒ ⇒
Also covered as part of the Emergency Medicine EOR, and Family Medicine EOR topic lists
