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Differential diagnosis

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Presentation on theme: "Differential diagnosis"— Presentation transcript:

1 Differential diagnosis
(鉴别诊断)

2 Linear IgA bullous dermatosis (线性IgA大疱性皮肤病)
Cause,incidence['insədəns] and risk factors Linear Ig A bullous dermatosis (LABD) is an acquired autoimmune [.ɔtɔi‘mjun] subepidermal [’sʌbepi‘də:məl]表皮下的blistering [’blistəriŋ]起泡的disorder with linear deposits沉积 of IgA along the basement membrane zone. Its cause is unclear, although it appears to have an immune-mediated 免疫介导的basis. Idiopathic[.idiə‘pæθik]先天性的, systemic disorder-related, and rarely drug-induced forms of LABD have been described. It almost always occurs in middle-aged people.

3 Symptoms The classic primary lesions of linear IgA dermatosis are clear and/or hemorrhagic 出血的round or oval vesicles 卵圆形的小囊泡or bullae[‘bulə]大疱的 on normal, erythematous, or urticarial 荨麻疹skin. Cutaneous [kju:’teiniəs]皮肤的manifestations 表现形式may also include erythematous plaques, blanching macules and papules, or targetoid erythema multiforme多形性–like lesions. Bullae may be discrete散在分布的 or arranged in a herpetiform 疱疹样的pattern, often described as the cluster簇集 of jewels sign. Alternatively, vesicles小囊泡 and bullae may be seen at the edge of annular环状的 or polycyclic [pɔli‘saiklik]多环的lesions, the appearance of which has been described as the string of beads sign (see the image below).

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6 Laboratory Studies Direct immunofluorescence study of both perilesional 病灶周围的skin and healthy skin typically shows linear deposition of IgA at the BMZ. Linear deposition of C3 may also be seen. Direct immunofluorescence study of salt-split skin reveals IgA deposition on either the dermal 真皮side (blister floor) or the epidermal表皮层 side (blister roof). Some patients demonstrate both linear IgA deposition and immunoglobulin G (IgG) deposition at the BMZ. Immunoglobulin M (IgM) deposition has rarely been reported.

7 Treatment dapsone(氨苯砜)is very important.

8 Pemphigus (天疱疮) Cause,incidence and risk factors
Pemphigus is an autoimmune disorder. The immune system produces bodies against specific proteins in the skin and mucus membranes. These antibodies break the bonds between skin cells. This leads to the formation of a blister. The exact cause is unknown. pemphigus is uncommon. It almost always occurs in middle-aged or older people.

9 Symptoms About 50% of people with this condition first develop painful blisters and sores in the mouth, followed by skin blisters. Skin sores may come and go. They may be located in the mouth or on the scalp头皮, trunk, or other skin areas, The skin sores may be described as erosion糜烂, oozing渗出, crusting结痂, peeling脱皮 or easily detached分离.

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12 Signs and tests Treatment
The skin separates easily when the surface of unaffected skin is rubbed 摩擦sideways with a cotton swab or finger. This is called a positive Nikolsky's sign. A skin biopsy is usually done to confirm the diagnosis. Treatment

13 Treatment is aimed at reducing symptoms, including pain
Treatment is aimed at reducing symptoms, including pain. It also aims to prevent complications并发症, especially infections .It may involve:1.antibiotics and antifungal 抗真菌medications to control or prevent infections 2.fluids and electrolytes given through a vein (IV)3.pain medications if local pain relief is not enough. Body-wide (systemic) therapy is needed to control pemphigus and should be started as early as possible.

14 Bullous pemphigoid (大疱性类天疱疮)
Cause,incidence and risk factors The cause is not known, but may be related to immune system disorders, certain other diseases, or use of some medications. Bullous pemphigoid usually occurs in elderly persons and is rare in young people. Symptoms come and go. In most patients, the condition goes away within 6 years.

15 Symptoms Some people may have no symptoms, others may have mild redness and irration.In severe cases, they are multiple blisters, called bullae. The blisters are usually located on the arms, legs, or middle of the body. About one-third of persons with bullous pemphigoid also develop blisters in the mouth. The blisters may break open and form ulcers or open sores. Other symptoms may include:itching rashes 皮疹mouth sores and bleeding gums.牙龈

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18 Signs and tests Treatment
Tests that may be done to help diagnose this condition include: Blood tests,Skin lesion biopsy Treatment Power anti-inflammatory medicines called corticosteroids may be prescribed. Some corticosteroids are taken by mouth, while others require a shot (injection).


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