Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

Presentation

Autoimmune Bullous Dermatoses: Practical Pearls

Description

The session on autoimmune blistering diseases presents important practical pearls to enhance clinical understanding and diagnosis. The first pearl emphasizes the need to evaluate for immune blistering diseases even in the absence of blisters, illustrated through various patient cases demonstrating conditions like linear IgA bullous dermatosis and dermatitis herpetiformis. The second pearl stresses the critical importance of recognizing infections, particularly as they can be fatal complications in patients with autoimmune diseases. Cases highlighted included linear IgA bullous dermatosis complicated by herpes simplex virus and bullous pemphigoid presenting with varicella-zoster virus infections. Finally, the third pearl underlines the significance of diagnostic precision in identifying specific variants of diseases, as the differential diagnosis impacts treatment strategies and potential associations with malignancies. The presentation advocates for comprehensive evaluation methods, including direct immunofluorescence and antibody testing, to ensure precise diagnosis and optimize patient outcomes.

View more

Conclusions

Evaluate for immunobullous diseases even in the absence of blisters.
Infection is a leading cause of death in patients with autoimmune blistering diseases.
Diagnostic precision is crucial for proper treatment and management of autoimmune blistering diseases.
Medications can induce linear IgA bullous dermatosis in patients, particularly those on vancomycin.
Patients with underlying malignancies and inflammatory bowel disease are at risk for developing adverse skin reactions.
Kaposi varicelliform eruption can complicate autoimmune blistering diseases and should be considered in worsening cases.
The presence of laminin-332 antibodies in mucous membrane pemphigoid is associated with a higher risk of malignancy.

Sara E. Billet, MD; Kimberly R. Kortuem, MD; Lawrence E. Gibson, MD; Rokea el-Azhary, MD, PhD, A Morbilliform Variant of Vancomycin-Induced, International Journal of Dermatology, 2013.
Adult-onset linear IgA bullous dermatosis: a retrospective single-center cohort study of 81 patients and literature review, International Journal of Dermatology.
Flann et al. Clin Exper Dermatol ., 2009.
Tu et al. Dermatol ., 2013.
Sandy Leger, MD; Damien Picard, MD, PhD; Saskia Ingen-Housz-Oro, MD; Jean-Philippe Arnault, MD; François Aubin, MD, PhD; et al., Prognostic Factors of Paraneoplastic Pemphigus, International Journal of Dermatology, Online First.
Michael M. Wolz, BMBCH, Carilyn N. Wieland, MD, Michael J. Camilleri, MD, Alison J. Bruce, MB, CHB, Marian T. McEvoy, MD, and Julia S. Lehman, MD, Pemphigus Vegetans Variant of IgA Pemphigus, a Variant of IgA Pemphigus and Other Autoimmune Blistering Disorders, International Journal of Dermatology.
B.J. Barrick, J.D. Barrick, C.H. Weaver, C.M. Lohse, C.N. Wieland, A.N. Kalaaji, and J.S. Lehman, Herpes Zoster in Patients With Bullous Pemphigoid: A Population-based Case-Control and Cohort Study, Br J Dermatol. 2016 May; 174(5): 1112-1114. doi:1.
Benjamin J. Barrick, BS, Christine M. Lohse, MS, and Julia S. Lehman, MD, Specific causes of death in patients with bullous pemphigoid as measured by death certificate data: a retrospective cohort study, International Journal of Dermatology.
Julia S Lehman, MD, Michael J Camilleri, MD, et al., Epidermolysis bullosa acquisita: concise review and practical considerations. International Journal of Dermatology 2009, 48, 227-236.