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By Lawrence A. Schiffman, DO, and Stephen
M. Schleicher, MD
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CASE:
An obese 76-year-old nursing home resident suffers from a
recurrent blistering rash on her abdomen. The patient is immobile
and frequently scratches the lesions. She is currently on
oral medications to control hypertension and diabetes. On
physical examination, tense bullae scattered on the abdomen
are noted in addition to excoriations and superficial ulcerations.
WHAT IS YOUR DIAGNOSIS?
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Punch biopsy acquired from a newly developed lesion revealed
bullous pemphigoid. This chronic condition involves deposition
of immunoglobulins within the dermis resulting in subepidermal
tense blisters. The average age of onset is 65, with an equal
incidence in males and females. This patient was treated with
ultra-high potency topical steroids and secondary infection
was prevented with topical mupirocin ointment. More extensive
disease often requires systemic prednisone for adequate control. |
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Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE
editorial board. Dr. Schiffman is currently a resident at
St. John's Episcopal Hospital in Far Rockaway, New York.
Emerg Med 37(10):33-34, 2005
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