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91 Cards in this Set
- Front
- Back
Vesicles
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Circumscribed
Fluid containing Epidermal elevations Size < 5 mm Lose identity in short time bullae ( > 5 mm) or pustule |
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Bullae/Blisters
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Rounded or irregularly shaped lesions
Fluid filled elevations serous or seropurulent material Bullae > 0.5 cm Blister > 1 cm Unilocular or multilocular |
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Pustules
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Circumscribed
Raised lesion May vary in size and shape Contains a purulent exudate Pus is composed of leukocytes with or without cellular debris, may contain bacteria or may be sterile |
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Diseases with vesicles
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Herpes Simplex
Varicella Herpes Zoster Scabies Dyshidrosis Contact Dermatitis |
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Herpes Simplex
Clinical |
clustered small vesicles
Recurrent episodes |
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Herpes Simplex
Course |
5-14 days per episode
-Viral shedding until crusted 4-7 days -Genital herpes --> asymptomatic shedding between outbreaks |
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Herpes Simplex
Diagnosis |
Tzanck smear, culture, PCR
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Herpes Simplex
Treatment |
sunscreen
symptomatic acyclovir famciclovir valacyclovir |
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HSV -1
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orolabial lesions
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HSV-2
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Genital lesions
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order: bullae, vesicles, blisters
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vesicles < bullae < blisters
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Orolabial Herpes
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“Cold sore” or “Fever blister”
HSV-1 in 95% of cases Prodrome: tingling, itching or burning Variable symptomatology: local discomfort, headache, nasal congestion, flu-like symptoms Sun exposure --> trigger RECURRENCES: cheeks, eyelids, earlobes, intraorally |
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Genital Herpes
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HSV-2 in 85% of cases
Spread by sexual contact Primary infection: grouped blisters and erosions in the vagina, rectum, penis x 7-14 days Fever, flu-like symptoms, vaginal pain and dysuria Management should be individualized |
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dysuria
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Difficulty or pain in urination
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Herpetic Whitlow
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Tenderness and erythema on the lateral nail fold
Deep-seated blisters develop 24-48 hours later 55% of cases between 20-40 yo More often seen in dentist, dental hygienists and health care workers - not seen as commonly anymore because of hand sanitizer |
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Herpetic keratoconjunctivitis
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Common cause of blindness in USA
Punctate or marginal keratitis or dendritic corneal ulcer --> disciform keratitis --> scars Topical corticosteroids --> perforation of the cornea Recurrences are common |
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Varicella (Chicken Pox)
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Varicella Zoster virus
90% of cases in children < 10 yo Incubation period is 10-21 days Transmission: direct contact with lesions and respiratory route |
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Varicella (Chicken Pox)
Clinical |
Fever, malaise, single vesicles on trunk and face
-“Dew drops on a rose petal” -Spreads out as first lesions heal -Old lesions become umbilicated |
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Varicella (Chicken Pox)
Complications |
secondary bacterial infection
osteomyelitis (rare) pneumonia (adults) |
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Varicella (Chicken Pox)
Treatment |
early acyclovir in adolescents and adults, topical antipruritic lotions, oatmeal baths, keep environment cool
-antibiotics are given as 2ndy tx |
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Why is aspirin contraindicated in Variclla
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Reye's Syndrome
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Herpes Zoster
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Varicella zoster virus
After natural infection or immunization, virus remain latent in the sensory dorsal root ganglion cells Reactivation --> immunosupression, age Clustered small vesicles along a dermatome Pain may precede the eruption May have lesions outside the dermatome |
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Herpes Zoster
Course |
10-21 days until clear
Viral shedding the first week Pain may be severe (burning, lancinating or triggered) May recur in 5% of patients Post-herpetic neuralgia more frequent in patients over the age of 50 |
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Herpes Zoster
Diagnosis |
clinical
Tzanck prep culture? PCR biopsy |
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Herpes Zoster
Treatment |
analgesics
thymidine kinase inhibitors (acyclovir, valacyclovir, famciclovir) antibiotics |
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Post-herpetic neuralgia
Treatment |
local applications of heat
capsaicin lidocaine 10% gel nerve blocks systemic steroids tricyclic antidepressants gabapentin |
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Scabies
Cause |
Disease caused by mite --> Sarcoptes scabiei
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Scabies
Clinical |
itchy red papules and vesicles
Web spaces, body folds, genitalia, breasts, elbows, wrists, ankles |
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Scabies
Course |
2-6 weeks after exposure
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Scabies
Diagnosis |
KOH scrap
scabies prep, response to treatment |
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Scabies
Treatment |
lindane
permethrin 5% Crotamiton thiabendazole sulfur 10% ivermectin 200 microgram/kg |
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Dyshidrotic Eczema
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Pompholyx
Etiologic factors: psychogenic, primary fungal, fungal id, drug reaction and idiopathic Sweat glands play a secondary role Itchy, tiny, clear vesicles on sides of digits, palms and soles Course: episodic flare, related to stress? Skin may become dry, cracked, flaky |
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Dyshidrotic Eczema
Diagnosis |
clinical
|
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Dyshidrotic Eczema
DDX |
contact dermatitis
palmo-plantar psoriasis |
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Dyshidrotic Eczema
Treatment |
topical steroids
tannic acid tar light treatments methotrexate for severe disease antibiotics for secondary infection avoid water and stress? |
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Allergic Contact Dermatitis
Clinical |
angular or linear distribution, history of exposure
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Allergic Contact Dermatitis
Course |
lesions develop within 1-10 days
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Allergic Contact Dermatitis
Causes |
poison ivy, oak, sumac
Nickel, rubber, thimerosal Neomycin, latex preservatives |
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Allergic Contact Dermatitis
Rx |
remove agent, corticosteroids
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Allergic Contact Dermatitis
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Allergic Disease
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Do they recommend neosporin?
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No b/c neosporin has neomycin
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Bullous Diseases
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Bullous Impetigo
Erythema Multiforme Pemphigus vulgaris Bullous Pemphigoid Porphyria Cutanea Tarda |
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Bullous Impetigo
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common, highly contagious bacterial skin infection of children
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Bullous Impetigo
Dx |
Gram stain, culture --> S. aureus
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Bullous Impetigo
Tx |
mupirocin 2% (Bactroban)
systemic antibiotics |
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Bullous Impetigo
Complications |
Staphylococcal scalded skin syndrome
glomerulonephritis scarring |
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Erythema Multiforme
Precipitating Factors |
Infections: herpes simplex (50%), Orf, Histoplasma capsulatum, mycoplasma pneumoniae
Radiation therapy Medications: (sulfa) |
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Erythema Multiforme
Clinical |
abrupt onset of symmetrical fixed red papules -->1-2 cm target (Bullseye) lesions on dorsa of hands, forearms, palms, neck, face and trunk. Mucosal involvement occurs 25%
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Erythema Multiforme
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Acute, self-limited, recurrent disease
bulls eye lesions |
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Pemphigus Vulgaris
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Autoimmune disease
Equal frequency in men and women; 5th or 6th decades Thin-walled, big flaccid, easily ruptured blisters... denuded areas Mouth involved (60%) then body --> groin, scalp, face, neck, axillae or genitals |
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Pemphigus Vulgaris
Dx |
Nikolsky Sign
Direct immunofluorescence shows intercellular IgG staining Antibodies to desmoglein 3 --> Elisa |
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Nikolsky sign
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absence of cohesion in the epidermis; lateral pressure on unblistered skin and having the epithelium shear off
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Pemphigus Vulgaris
Treatment |
silver sulfadiazine 1%
systemic corticosteroids other immune modulating agents (azathioprine, cyclophosphamide, methotrexate) |
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Bullous Pemphigoid
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Autoimmune disease, affects the elderly
Intense pruritic eruption with large tense blisters (subepidermal) Most often begins on lower extremities. Other sites: groin, axillae, flexor surfaces of forearms Associated with diabetes mellitus, rheumatoid arthritis, dermatomyositis, ulcerative colitis, lymphoproliferative disorders |
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What is deeper Pemphigus Vulgaris or Bullous Pemphigoid?
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Bullous Pemphigoid
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Bullous Pemphigoid
Dx |
Circulating basement membrane zone antibodies (IgG) 70%
Direct immunofluorescence shows linear deposits of IgG and C-3 along the BMZ Indirect immunofluorescence on salt-split skin |
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Bullous Pemphigoid
Tx |
corticosteroids (lower doses than PV)
immunosuppressives (azathioprine, methotrexate, mycophenolate mofetil) |
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Porphyria Cutanea Tarda
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Metabolic disease: abnormal porphyrin metabolism (Uroporphyrin decarboxylase)
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Porphyria Cutanea Tarda
Clinical |
photosensitivity --> blisters, erosions on dorsa of hands and arms; heal with scarring, milia and dyspigmentation
Hyperpigmentation of the face, neck and hands Increased facial hair Photosensitivity |
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Porphyria Cutanea Tarda
Triggers |
ETOH, estrogens, iron overload (66%), hepatitis C, hepatitis B
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Porphyria Cutanea Tarda
Diagnosis |
pink or coral-red fluorescent urine (increased uroporphyrins) under a Wood’s UV light
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Porphyria Cutanea Tarda
Treatment |
remove trigger
decrease iron (phlebotomy) alpha interferon for hepatitis C antimalarials |
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What disease is associated with Porphyria Cutanea Tarda?
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diabetes mellitus, lupus
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Diseases with pustules
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Acne vulgaris
Acne rosacea Folliculitis Candidal intertrigo |
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Acne Vulgaris
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A chronic inflammatory disease of the pilosebaceous unit
True acne is a follicular process beginning with the comedon Rupture results in inflammation -Papules, pustules, or cysts |
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What is the most common dermatologic condition treated by physicians in the US?
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Acne Vulgaris
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Acne vulgaris incidence
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40-50 million individuals/year
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What age does acne vulgaris predominate in?
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Acne can occur at any age --> predominately teens
85% of 12-24 year old 3% of 35-44 year old |
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Acne Vulgaris
Classification |
According to type of lesion:
Comedonal, papulopustular, cystic According to severity: Mild, moderate, severe |
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Acne Vulgaris
Topical Treatment |
Tretinoin
Benzoyl peroxide Antibiotics Azelaic acid Salicylic acid Alpha-hydroxy acids |
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Acne Vulgaris
Oral Treatment |
Antibiotics: doxycycline, minocycline
Estrogens (oral contraceptives) Retinoids (Accutane 40 mg bid x 4 months) Antiandrogens: spironolactone |
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Which acne drug is teratogenic?
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Accutane
So don't use during pregnancy |
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Rosacea
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Most common in fair-skin individuals
Third or Fourth decades of life Pathogenesis related to vascular hyper-reactivity (lesser role: Role of Demodex folliculorum and Propionibacterium acnes) |
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Rosacea
Triggers |
Hot drinks
red wine spicy food soy sauce oral niacin topical steroids |
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Vascular rosacea
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flushing and facial erythema with or without telangiectasia
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Papulopustular rosacea
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central facial erythema with papules or pustules
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Ocular rosacea
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foreign body sensation
burning dryness itching ocular photosensitivity blurred vision |
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Granulomatous rosacea
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firm, brown or red papules or nodules
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Rosacea
Oral Treatment |
Metronidazole 1% gel qd
Tetracycline, 250 mg bid Doxycycline, 100 mg qd (best b/c low dose) Minocycline 100 mg qd |
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Rosacea
Topical Treatment |
Sodium sulfacetamide 10%
Azelaic acid 20% bid Erythromycin 2% bid Clindamycin lotion bid Metronidazol 200 mg bid |
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Rosacea
Interventional Treatment |
Telangiectasias: Laser treatment
Rhinophyma: Laser, cryosurgery, electrosurgery |
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Folliculitis
Clinical |
pustules at hair follicle, especially the extremities
|
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Folliculitis
Complications |
rupture of follicle with carbuncle or furuncle
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Folliculitis
Dx |
culture, clinical
Staphylococcus aureus (normal inhabitant of anterior nares in 20% adults) |
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Folliculitis
Treatment |
antibacterial soap, oral antibiotics, mupirocin; rifampin (600 mg/day 10 days)
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Candidal Intertrigo
typical causes |
Typically caused by C. albicans but other species can cause infection
|
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Candidal Intertrigo
Clinical |
groin, under breasts, abdominal fat, axillae
Red, moist areas with satellite papules and pustules |
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Candidal Intertrigo
Diagnosis |
clinical, KOH, culture
|
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Candidal Intertrigo
Treatment |
topical antifungals
Silvadene zinc oxide oral antifungals (fluconazole, itraconazole) |
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Other Sources of Blisters
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Burns
Acute fungal infections causing tinea corporis Drug Reactions (Stevens-Johnson, TEN) Friction Insect Bites Many autoimmune blistering diseases |
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What is seen with immunofluorescence with Bullous Pemphigoid vs. Pemphigus Vulgaris?
|
PV: Direct immunofluorescence shows intercellular IgG staining
BP: Direct immunofluorescence shows linear deposits of IgG and C-3 along the BMZ Indirect immunofluorescence on salt-split skin |