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Derm Vascular Abnormalities
Telangiectasias
- Dilated tiny blood vessels of the skin which look weird, but are usually a nonissue
Causes
- There are many causes. Here are a few I would know.
- Cushing’s Syndrome
- Systemic Scleroderma
- Venous hypertension
- Trauma
- Acne Rosacea
- Blepharitis
Clinical Presentation
- Tiny red dilated blood vessels in the skin
Treatment
- Sclerotherapy
- Laser therapy
Cherry Angioma
- Benign tumor
- Involves dermal capillaries
- Increase in number with age
Clinical Presentation
- Red (cherry) papule on the skin
Treatment
- None
- Electrocautery
- Laser removal
Bullous Pemphigoid
- Chronic autoimmune
- No definite precipitating factor though genetics and environmental factors combined are believed to be involved.
Clinical presentation
- Typically patients are older than 60
- Pruritus may be presenting symptom
- Initially, urticarial rash (hives) which can last for months
- ** Tense bullae** (large blisters > 10 mm ) typically found in the groin, upper thighs and flexor surfaces of the elbows. It may be located anywhere, including the mouth.
- Cycles of eruption and remission
- Negative Nikolsky sign
Labs & Studies
- Biopsy
- Immunofluorescence for IgG
Treatment
- Topical steroids for minor outbreaks
- Oral steroids for more severe case
- Antibiotics for secondary infections
- Fluid and electrolyte management
Pemphigus Vulgaris
- Autoimmune disease with loss of cell to cell adhesion leading to skin manifestation.
- Before antibiotics and steroid therapy pemphigus vulgaris was a fatal disease.
Clinical Presentation
- Middle-aged patient
- Initially painful lesions on mucosal surfaces (mouth)
- Skin lesions erupt several months later
- Clear fluid-filled vesicles or bullae which are flaccid and easily ruptured
Labs, Studies and Physical Exam Findings
- Painful lesions in the mouth
- Clear fluid-filled vesicles or bullae which are flaccid and easily ruptured
- Positive Nikolsky sign (Rub the skin and blister forms. This makes sense. The whole problem is with cell to cell adhesion)
- Biopsy and immunofluorescence for IgG
Treatment
- Oral or IV steroids
- Antibiotics for secondary infections
- Fluid and electrolyte management
