By Lawrence S Chan
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Extra info for Blistering Skin Diseases
Some investigators have observed that IVIG rapidly and selectively lowers the IgG autoantibodies in pemphigus, and reported an average of 70% reduction in 1 week after a single cycle of treatment, without lowering other antibodies . Antibody rebound, one of the difficulties encountered in IVIG or plasmapheresis treatment, can be prevented by concurrent administration of IVIG and immunosuppressives such as cyclophosphamide or azathioprine [8; 9; 48]. Most recently, a humanized mouse monoclonal antibody against B-cell antigen CD20, rituximab, has been used successfully in several cases [41; 21].
Hematoxylin and eosin stain. 37 Laboratory findings Lesional skin biopsy obtained for regular histopathology delineates an intraepidermal blister accompanied with neutrophilic infiltration and scanty acantholysis (36). For the SPD subtype, the neutrophils are present on the subcorneal location, whereas for the IEN subtype, the neutrophils are observed in the lower epidermis or in the entire epidermis (37) . Perilesional skin biopsy obtained for direct immunofluorescence microscopy reveals IgA deposits at the epidermal cell surface at the upper epidermis and lower (38) or entire epidermis in the SPD subtype and IEN subtype of diseases, respectively.
A recent article showed that mycophenolate mofetil has similar effectiveness but a lower liver toxicity profile than azathioprine in a European prospective randomized nonblinded clinical trial of BP treatment [118a]. í LICHEN PLANUS PEMPHIGOIDES í Lexicon-format morphological terminology • • • • • • • • • • • Primary lesions: vesicle; bulla; papule; plaque Secondary features: crusting; scales Individual lesions: round; oval; annular; polygonal Multiple lesion arrangements: scattered skin Distribution: scattered skin Locations: scattered skin Signs: Koebner; Wickham striae Textures and patterns: lichenoid; Wickham striae Consistency: firm; tense Color of lesions: skin; erythematous; violaceous Color of body: normal 54 Lichen planus pemphigoides manifests with vesicles and bullae, on both normalappearing skin and on violaceous lichen planus papules and plaques, commonly involving the extremities.
Blistering Skin Diseases by Lawrence S Chan