[Quiz] pruritic rash with blisters

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A 68-year-old woman presents with a two month history of a widespread pruritic rash.
Examination reveals widespread erythema with several small blisters containing straw-
coloured fluid and one or two larger serosanguineous blisters.
What is the most likely diagnosis?
(Please select 1 option)

  1. Bullous impetigo 
  2. Bullous pemphigoid 
  3. Insect bite 
  4. Scabies 
  5. Urticarial vasculitis 


Answer

Pemphigoid, erythema multiforme and herpes are the commonest causes of a blistering rash.
The history above is a classic description of bullous pemphigoid (BP).
Immunoglobulin (Ig)G autoantibodies bind to the skin basement membrane in patients with
BP. The binding of antibodies at the basement membrane activates complement and
inflammatory mediators.
Activation of the complement system is thought to play a critical role in attracting
inflammatory cells to the basement membrane. These inflammatory cells are postulated to
release proteases, which degrade hemidesmosomal proteins and lead to blister formation.
Eosinophils are characteristically present in blisters as demonstrated by histopathologic
analysis, although their presence is not an absolute diagnostic criterion.


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