Blistering Dermatoses

Blistering Dermatoses by Margaret Bobonich DNP, FNP-C

• An immunohistochemical test is required to diagnose an autoimmune blistering disease. A perilesional skin biopsy for direct immunofluorescent (DIF) is the most sensitive test for bullous pemphigoid (BP). An indirect immunofluorescence (IIF) on salt split skin is less sensitive but more specific. Enzyme-linked immunosorbent assays (ELISA) support the diagnosis and are helpful for monitoring disease activity.
• A significant number of patients with bullous pemphigoid present without any blisters and can be misdiagnosed. In patients over 60 yrs old with unexplained pruritus, eczematous or urticarial eruptions, consider BP in the differential diagnosis.
• Systemic glucocorticoids are first-line but the combination of rituximab and prednisone as initial therapy for moderate to severe pemphigus have improved patient outcomes.