BULLOUS DISEASES OF SKIN

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Presentation transcript:

BULLOUS DISEASES OF SKIN WEL COME TO SEMINAR ON BULLOUS DISEASES OF SKIN

CASE HISTORY  Age : About 25 year  Sex : Female NAME : MARJINA BEGUM  Age : About 25 year  Sex : Female  Marital Status: Married  Occupation : House wife.

Address :. Vill : Kujghar,. Post : Kujghar,P. S. : Sadar, Address : Vill : Kujghar, Post : Kujghar,P.S.: Sadar, Dist : Jamalpur.  Date of Admission: 08-11-2005  Date of Examination: 09-11-2005

CHIEF COMPLAINTS  Diffuse painful blisters & crusted lesions over scalp, face, trunk, upper extrimities & groin.For about 1½ month. A few small blisters in mouth cavity For 7 days.

H/O PRESENT ILLNESS The patient states that she was all right about six months back. Then she developed a few blisters with itching at lower part of back of Lt painful blisters

side. Subsequently after 4 months she developed various sizedassociated with itching at her chest, back, upper extrimities, scalp, face, groin & a few painful lesions is oral mucous membrane which became crusted,

With above complaints she was admitted in Mymensingh Medical College Hospital for proper management. exfoliative, reddened with moist surface

H/O PAST ILLNESS. Nothing contributory. Personal History: Married for 4 years. No issue. Menstruation : Regular. Habitchewing of battle nut +

family members suffered from any such notable disease.  Family History: No any of her family members suffered from any such notable disease.

 Treatment History: Patient was admitted with complaint mentioned in MMCH on 20-10-2005 & was treated with long acting steroid triamcinolone acetonide parenterally & was improved.

GENERAL EXAMINATION.  Appearance : Ill looking.  Body build : Average.  Anaemia  Jaundice Absent.  Cyanosis

 Oedema  Dehydration  Clubbing  Koilonychia  Hair  Nail Absent Absent Normal

 Pulse : 86/min/reg/mod.  B.P : 120/35mm of Hg.  Temp : Normal  Respiration : 14/min.  Neck veins : Not engorged.  Lymph Node : Not palpable.

EXAMINATION OF INTEGUMENTARY SYSTEM.  Inspection Vesicles & bulla on scalp, face, chest, back, upper extrimities, groin, some on normal skin & some are erythomatous based.

Crust & erosions with. scaling in some areas & Crust & erosions with scaling in some areas & superfical ulceration in oral cavity.

 Palpation : Vesicles & bullae are flacid, tenderness present NIKOLSKY Sign - Present.Bulla – spread plenomenon (The Asboe- Hansen sign) – Present.

EXAMINATION OF OTHER SYSTEM : NAD except a few oral mucosal lesions.

SALIENT FEATURES. Marjina Begum, Age about 25 years of vill Kujghar, Jamalpur was admitted in MMCH on 08-11-05 with complaints of progressive development of painful blisters. Crust, erosions & exfoliative lesions associated with itching

over scalp, face, trunk, upper arms, groin & a few small painful blisters in oral cavity. Examination shows flaccid & vesicles, Bullae, crusted & exfoliative lesions with erythomatous base at the mentioned sites. The lesions are

Nikolsky sign – Present Bulla – Spread Phenomenon – Present. tender, moist with malodourous condition & a few superficial erosions in oral mucous membrane. Nikolsky sign – Present Bulla – Spread Phenomenon – Present.

PROVISIONAL DIAGNOSIS.  Pemphigus foliaceous.  D/D. : Pemphigus Vulguris. Pemphigus vegetans. Bullous Pemphigoid. SSSS Cicatrical Pemphigoid. Stevens johnson syndorme & TEN.

INVESTIGATION.  Skin biopsy for Histopathology & IF test.  Blood for TC DC Hb% ESR - 6600/cmm. N-62%, L-32%, M-02%, E-0%, Hb%- 80%,ESR- 10mm/1st hour.

 Random blood suger.- 103mg/100 ml.  Urine for R/E. - NAD  Blood Urea. - 18mg/100ml.  Serum creatinine. - 1.0mg/100ml.

BIOPSY FOR HISTOPATHOLOGY :  Finding : Pemphigus compatible with pemphigus foliaceous. CONFIRMATORY DIAGNOSIS.  Pemphigus foliaceous.

TREATMENT.  Inj. - TRIAMCINOLONE ACETONID 1AMP I/M stat and 1amp on 3rd day & 1 amp on 7th day.  Tab. - Prednisolon -80mg/day.  Tab. - Neotack (150mg) 1+0+1 daily.

TREATMENT(Contd).  Cap. - Sefradine (500mg)1+1+1+1 daily.  Tab. - Alatrol 0+0+1 daily.  Potash wash - daily.1% Silver sulphadiazine ointment - daily.

SALIENT FEATURE. Mr. Sumon Das, son of Dr. Kanu Das, aged 29 years hailing form Jamalpur was admitted in MMCH, Cabin-7 on 28th November,2005. He was referred to skin & VD OPD on 30th Nov. 05 with the complaints of exfoliation of

skin with generalized mild itching for 20 days, a known case of hypothyroidism due to thyroidectomy 3 months back & bronchial asthma from childhood. On examination we found extensive scaling all over the skin with erythema

and itching, mild leg oedema & puffy face and itching, mild leg oedema & puffy face. Pt’s pulse was 96/min, BP= 120/65 mm of Hg, temp. = 101.40F, lungs, heart & urinary output – normal. There was no mucous membrane and nail changes. Pt. also complaints of

chilling & gave H/O taking tab chilling & gave H/O taking tab. Ibuprofen 20 days back and also paracetamol & azithromycin. With these above features our diagnosis is drug induced exfoliative dermatitis.