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DERMATOLOGY

DIAGNOSIS

■ Positive Tzanck test showing acantholytic cells, confirmed by serum

immunofluorescence

TREATMENT

■ Pain control, local wound care, antibiotics for secondary infection, and

oral steroids

■ Prior to steroid introduction the mortality rate was 95% due to spread of

disease, secondary infection, dehydration, and thromboembolism. The

mortality rate is now 10–15%.

BULLOUS PEMPHIGOID

Bullous pemphigoid is a chronic autoimmune blistering disease. Patients are

typically older than pemphigus patients (>60 years old) and blister formation

occurs deeper (within the epidermal basement membrane). Prognosis is better

than for pemphigus vulgaris.

SYMPTOMS/EXAM

■ Large, tense blisters (1–4 cm) arise from normal or pink, urticarial appearing

skin. Affected skin may be intensely pruritic. Ulceration and tissue loss can

follow.

■ Axilla and groin are commonly affected sites.

■ Oral lesions are rare.

■ Due to the depth at which blisters form, Nikolsky sign is negativein bul-

lous pemphigoid.

TREATMENT

■ Limited disease: Nicotinamide, doxycycline, and ultrapotent topical steroids

■ Extensive disease: Oral steroids, methotrexate

SYPHILIS

ETIOLOGY

■ T. pallidum infection from direct contact with an infected individual

SYMPTOMS/EXAM

■ Primary stage: Painless, usually single chancre (1 cm ulcer with clean

base and raised borders) on genitalia or in mouth (see Figure 17.6)

■ Secondary: 3–6 weeks later sore throat, fever, malaise, LAD, and rash; dull

pink-red papular rash starts on trunk and flexor surfaces of the extremities

and spreads to the palms and soles

■ Condyloma lata: Secondary syphilis infection in the genital area with a

moist, flat, verrucous appearance

■ Tertiary: 3–20 years after initial infection; nervous system, cardiovascular

involvement, and widespread granulomatous lesions (gummas)

DIAGNOSIS/TREATMENT

■ Penicillin or doxycycline; for details, see “Infectious Disease,” in Chapter 8

Treponema pallidumis a

spirochete, a flagellated

Gram-negative bacteria. Other

spirochetes include Leptospira

sp. (Leptospirosis) and

Borrelia burgdorferi (Lyme

disease).