Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks...
Transcript of Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks...
![Page 1: Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs. • Bullous](https://reader033.fdocuments.net/reader033/viewer/2022060714/607a8ff51177dc2bef5625e5/html5/thumbnails/1.jpg)
Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs.
• Bullous lichen planus• Lichen planus
pemphigoides• Lichenoid drug eruption• Bullous pemphigoid
![Page 2: Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs. • Bullous](https://reader033.fdocuments.net/reader033/viewer/2022060714/607a8ff51177dc2bef5625e5/html5/thumbnails/2.jpg)
![Page 3: Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs. • Bullous](https://reader033.fdocuments.net/reader033/viewer/2022060714/607a8ff51177dc2bef5625e5/html5/thumbnails/3.jpg)
![Page 4: Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs. • Bullous](https://reader033.fdocuments.net/reader033/viewer/2022060714/607a8ff51177dc2bef5625e5/html5/thumbnails/4.jpg)
![Page 5: Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs. • Bullous](https://reader033.fdocuments.net/reader033/viewer/2022060714/607a8ff51177dc2bef5625e5/html5/thumbnails/5.jpg)
IgG
![Page 6: Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs. • Bullous](https://reader033.fdocuments.net/reader033/viewer/2022060714/607a8ff51177dc2bef5625e5/html5/thumbnails/6.jpg)
Case 27: Diagnosis
• Bullous lichen planus
• Lichenoid drug eruption
• Lichen planus pemphigoides
• Bullous pemphigoid
![Page 7: Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs. • Bullous](https://reader033.fdocuments.net/reader033/viewer/2022060714/607a8ff51177dc2bef5625e5/html5/thumbnails/7.jpg)
Lichen planus pemphigoides
• Rare condition (<100 reported cases) (Kaposi 1892).
• Young adults generally affected, M>F, usually idiopathic –some drug related and paraneoplastic.
• Lichenoid eruption > blisters.
• Blisters develop on normal / erythematous skin or lichenoid areas.
• Epitope sharing: dense lichenoid inflammation > exposure of BMZ antigens> circulating autoantibodies.
![Page 8: Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs. • Bullous](https://reader033.fdocuments.net/reader033/viewer/2022060714/607a8ff51177dc2bef5625e5/html5/thumbnails/8.jpg)
• Combination of lichenoid interface dermatitis and subepidermal vesiculobullous dermatitis but variable.
• Some cases show cell poor subepidermal blisters with LP like changes at the periphery.
• Immunofluorescence profile similar to BP.
Lichen planus pemphigoides
![Page 9: Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs. • Bullous](https://reader033.fdocuments.net/reader033/viewer/2022060714/607a8ff51177dc2bef5625e5/html5/thumbnails/9.jpg)
Case 27: Differential diagnosis
• Bullous lichen planus
• Lichenoid drug eruption
• Lichen planus pemphigoides
• Bullous pemphigoid
![Page 10: Case 27: Male 22 yrs. 4 wks H/O generalized eruption with ...€¦ · Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs. • Bullous](https://reader033.fdocuments.net/reader033/viewer/2022060714/607a8ff51177dc2bef5625e5/html5/thumbnails/10.jpg)
Lichen planus pemphigoides: learning points
• Consider as a possibility when a subepidermal blisters develops in the context of a lichenoid interface dermatitis.
• Correlation with the clinical presentation and immunofluorescence profile may be needed to differentiate LPP from paraneoplastic pemphigoid.
• Prognosis and response to treatment much better than bullous pemphigoid.