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Blistering diseases in the elderly
Published in Robert A. Norman, Geriatric Dermatology, 2020
In addition, bullous and urticarial pemphigoid presentations include vesicular, papular, vegetating, seborrheic and erythrodermic22,23. The papular or nodular variety, also known as pemphigoid nodularis, presents initially as hyperkeratotic nodules mat later progress to bullae over several years23,24. The erythrodermic variant is a generalized erythema occurring with bullae while the vesicular variant presents as heterogeneous vesiculobullous lesions. A bullous pemphigoid-like disease has been associated with some drugs, including furosemide and phenacetin18,22. Lichen planus and psoriasis have been associated with bullous pemphigoid, as have autoimmune diseases such as diabetes, pernicious anemia, rheumatoid arthritis and multiple sclerosis. Bullous pemphigoid has been seen in malignancies of the gastrointestinal tract, urinary tract, lymphoreticular system, pancreas, genitalia, breast, lung and skin18,25. However, no causal relationship has been established.
Bullous pemphigoid
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Dipankar De, Sheetanshu Kumar, Sanjeev Handa
In up to 20% of BP cases, characteristic bullous lesions never develop during the entire course of disease. In these cases, nonspecific urticarial and eczematous lesions are the only manifestations throughout the entire course [38]. An eczematous variant is characterized by eczematous plaques, excoriated papules, and nodules associated with severe pruritus [39]. Similarly, an urticarial variant presents with pruritic urticarial lesions. Pemphigoid nodularis is another such variant characterized by prurigo-like nodules on distal extremities. Bullous lesions are present only occasionally in pemphigoid nodularis [31].
Sulfonamides
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Natasha E. Holmes, M. Lindsay Grayson
These drugs may also be useful for bullous pemphigoid and chronic bullous dermatosis of childhood (Ahmed and Moy, 1982). The anti-inflammatory effect of sulfapyridine is thought to be due to impairment of neutrophils and monocytes and inhibition of cyclo-oxygenase and lipoxygenase-dependent pathways (Elder et al., 1996). Sulfamethoxypyridazine has been studied in the treatment of topical steroid-refractory mucous membrane pemphigoid (Thornhill et al., 2000). There was a significant improvement in objective clinical scores and pain scores with a 1-g daily dose. Three of 25 patients (12%) were withdrawn because of side effects (allergic reaction, hemolysis). It has also been used in combination for steroid-refractory pemphigoid nodularis (500–1500 mg daily) without adverse effects (Gach et al., 2005).
Pathophysiology, diagnosis, and pharmacological treatment of prurigo nodularis
Published in Expert Review of Clinical Pharmacology, 2021
Kyle A. Williams, Youkyung S. Roh, Isabelle Brown, Nishadh Sutaria, Pegah Bakhshi, Justin Choi, Sylvie Gabriel, Rajeev Chavda, Shawn G. Kwatra
There are several dermatologic conditions that can mimic PN that should be considered when evaluating patients. Pemphigoid nodularis, a rare variant of bullous pemphigoid, is characterized by pruritic nodules, papules, or plaques that mimic PN both clinically and histologically [44]. It may be especially challenging to distinguish the two conditions as they tend to affect populations of similar age groups (50s to 60s) with female predominance [44]. Additionally, pemphigoid nodularis can arise in the context of other chronic pruritic conditions, including PN [45–48], so it is helpful to be cognizant of this diagnosis in patients with persistent pruritus, even in established PN patients. Compared to PN, however, pemphigoid nodularis often presents with larger plaques with areas of central erosion, ulceration, and/or blistering traditionally seen in bullous diseases [4,49]. A pathognomonic feature is seen on biopsy, which shows subepidermal clefting, and linear deposition of IgG and C3 along the basement membrane zone on direct immunofluorescence (DIF) staining, which is absent in PN. Patients also have circulating autoantibodies against the basement membrane zone [50].