Internal Medicine

0521779407-B02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Bullous Pemphigoid 267

differential diagnosis

■Bullous impetigo – impetigo bullae are flaccid

■Other Immunologically mediated blistering diseases: See below

management

What to Do First

■Skin biopsy of intact blister and adjacent normal skin

General Measures

■Antibiotics for secondary infections, wet dressings, anti-pruritics

specific therapy

■Localized disease: potent topical corticosteroids

■Widespread disease: systemic corticosteroids (e.g., prednisone)

■Consider corticosteroid-sparing agents such as tetracycline, dap-

sone, azathioprine, mycophenolate mofetil, cyclophosphamide,

methotrexate, intravenous immune globulin, rituximab

Side Effects & Contraindications

■Topical corticosteroids

➣Side Effects

Atrophy, striae, purpura, telangiectasia, hypopigmentation,

delayed wound healing

➣Contraindications

Absolute: none

■Prednisone

➣Side Effects

Hypertension, myopathy, osteoporosis, peptic ulcers, impair-

ed wound healing, growth suppression, diabetes mellitus, sup-

pression of the hypothalamic-pituitary-adrenal axis, cataracts,

mood alterations

➣Contraindications

Absolute: none

Relative: Systemic infection, Pregnancy, nursing mother

■Tetracycline

➣Side Effects

Tooth discoloration, photosensitivity, pseudotumor cerebri,

decreased effectiveness of OCP’s, anorexia, nausea, vomiting,

and diarrhea

➣Contraindications

Absolute: hypersensitivity to any tetracycline, last (^1) / 2 of preg-
nancy, infancy to 8 years of age