1. 6-year-old girl, with a 3-month history of a pruritic eruption, which began on the trunk and then gradually extended to the face and extremities. examination showed vesicules and bullae on annular, polycyclic, and erythematous plaques, leaving residual hyperpigmentation No oral mucosal involvement was present. The remaining physical examination was otherwise normal
Case 7.

2. acantholysis of the superficial parts of the epidermis.

3. Direct immunofluorescence showed positive intercellular IgG and C3 staining throughout the epidermis and on the dermo-epidermal junction
The child was diagnosed as/ ??

4. pemphigus herpetiformis

5. Pemphigus herpetiformis
clinical features of dermatitis herpetiformis with the immunopathologic features of pemphigus
IgG ,+_ IgA , intercelluar without mucous membrane involvement and a negative nikolsky sign
that respond good to Dapsone
Or azathioprine + corticosteroids..

6. Managementof Pemphigus .Herpetif./
dapsone at an initial dose of 2 mg/kg/day. continued to be maintained (up to 24 months after the initial diagnosis).
plus prednisone that was reduced gradually then stopped after 3 months of treatment.

7. Case :no 8. An elderly female (72 year old)with recent onset of eye disease and blurred vision and oral erosion and poor feeding ,,pain in mucosae

8. Pathologically: Conjunctival biopsy for the separation of the epithelium from the inflammed substantia propria.

9. Cicatricial pemphigoid

10. Ocular form LABD resembles C
Ocular form LABD resembles C.P/ but immunodeposits differ from point of view of DIF.
C.P
LABD

11. Case 9: A pregnant lady(second trimester)
DIF ,,linear deposits along BMZ of/IgG

12. Herpes(pemphigoid ) Gestationis

13. Herpes G./ It begins usually in second or third trimester and resembles clinically and histologically to BP.

14. In herpes G./ autoantibodies against two hemidesmosomal antigens: BPAG1 and BPAG2. Clinical diagnosis is confirmed by histology and positive cutaneous immunofluorescence tests. The most discriminant examination for other pruritic dermatoses of pregnancy is the enzyme-linked immunosorbent assay (Elisa) NC16A BP First-line treatment is local corticosteroid therapy; if local treatment fails, general corticosteroid therapy should be adminstered.

15. herpes gestationis: interaction of IgG1 auto-antibodies and the 180 kD BPA2 remains paramount in understanding the immunologic mechanism of disease.

16. Case 10: 6 month history of pruritic urticarial plaques and vesicles that started on her trunk and became more generalized. She developed occasional vesicles in her mouth, but examination failed to reveal any mucous membrane lesions. except for intermittent pruritus, her activity was normal. A skin biopsy showed a subepidermal blister with a mixed dermal inflammatory infiltrate and linear deposition IgG at the dermal-epidermal junction. Salt split skin showed staining on the bottom of the blister

17. EBA

18. EBA : autoantibodies against type VII collagen (C7), an integral component of anchoring fibrils (AFs), which are responsible for attaching the dermis to the epidermis.

19. EBA: A Form of epidermolysis bullosa characterized by trauma-induced, subepidermal blistering with no family history of the disease. Direct immunofluorescence shows IgG deposited at the dermo-epidermal junction.

20. Case no.11
a middle age adult female with recent Hx: of/ Seborrheic like lesions unresponsive to antifungal creams and washes

21. Pemphigus erythematosus (a variant of pemphigus foliaceus

22. P.Erythematous Seborrheic areas are often involved DIF both reminding of LE and P.Foliaceus and ANA often + P.erythematous is more localized than P.foliaceus./

23. A case of Pemphigus.FOliaceus.
pruritic, burning, or painful dermatitis, most often in a seborrheic distribution, small flaccid intraepidermal bullae and erosions. Exacerbation by sun exposure.

24. Intensely itchy papulovesicles exacerbated with iodides
Quizz: no.1
Intensely itchy papulovesicles exacerbated with iodides

25. Quizz,no.2 What isthis test ,,that is done by a physician??

26. Quizz,no.3 malar rash with erythema and scaling ,DIF and ANA +

27. Quizz.no.4 PAINFUL EROSIONS and painnful paronychia, this disease in common in middle age and Jews

28. Quizz No.5 A 54 -yr -old female with recalcitrant cheilitis and stomatitis?

29. Quizz. No 6
A rare variant of immunobullous dis. predominance of facial and intertriginous lesions, heal with verrucoid granulations. Two types exist

30. quizz,no.7 A middle age lady with 9 month history of vesicular , eroded papular lesions& milia of hands and feet , no other areas involved

31. quizz.no.8 a 76 yr –old- lady with recent bulla and itching over exterimities and trunk her feet are red and edematous with studded bullae

32. quizz no.9 Bp
The mechanism involves autoantibodies directed against antigens in the lamina lucida and hemidesmosomes of basal keratinocytes, ….. and …….
……belongs to the plakin family and is restricted to the intracellular hemidesmosomal plaque,
whereas the ……. is a transmembrane glycoprotein with intracellular and extracellular interactions with hemidesmosomes.
The most common immunoglobulin overexpression is of …, …., ….. and less frequently of …..types.

33. Quizz.no.10 Bullous Pemphigoid: alternative treatment options such as ….. and ………., this combination anti-inflammatory regime is only useful in those with limited or localized disease e.g. acral bullous pemphigoid

34. Intensely itchy papulovesicles
Quizz: no.1
Intensely itchy papulovesicles

35. Dermatitis Herpetiformis

36. Quizz,no.2 What isthis test ,,that is done by a physician??

37. nikolsky's sign

38. Quizz,no.3 malar rash with erythema and scaling ,DIF and ANA +

39. p.Erythematous senear Usher syn.

40. Quizz.no.4 PAINFUL EROSIONS and painnful paronychia, this disease in common in middle age and Jews

41. Pemphigus vulgaris

42. Quizz No.5 A 54 -yr -old female with recalcitrant cheilitis and stomatitis?

43. Paraneoplastic Pemphigus

44. Quizz. No 6
A rare variant of immunobullous dis. predominance of facial and intertriginous lesions, heal with verrucoid granulations. Two types exist

45. Pemphigus vegetans

46. quizz,no.7 A middle age lady with 9 month history of vesicular , eroded papular lesions& milia of hands and feet , no other areas involved

47. EBA epidermolysis bullosa aquisita

48. quizz.no.8 a 76 yr –old- lady with recent bulla and itching over exterimities and trunk her feet are red and edematous with studded bullae

49. Bullous pemphigoid

50. quizz no.9 Bp
The mechanism involves autoantibodies directed against antigens in the lamina lucida and hemidesmosomes of basal keratinocytes, ….. and …….
……belongs to the plakin family and is restricted to the intracellular hemidesmosomal plaque,
whereas the ……. is a transmembrane glycoprotein with intracellular and extracellular interactions with hemidesmosomes.
The most common immunoglobulin overexpression is of …, …., ….. and less frequently of …..types.

51. BP
The mechanism involves autoantibodies directed against antigens in the lamina lucida and hemidesmosomes of basal keratinocytes, BPAg1 (230) and BPAg2 (180). BPAg1 belongs to the plakin family and is restricted to the intracellular hemidesmosomal plaque, whereas the BPAg2 is a transmembrane glycoprotein with intracellular and extracellular interactions with hemidesmosomes. The most common immunoglobulin overexpression is of IgG4, IgG1, IgE and less frequently of IgA types.

52. Quizz.no.10 Bullous Pemphigoid: alternative treatment options such as ….. and ………., this combination anti-inflammatory regime is only useful in those with limited or localized disease e.g. acral bullous pemphigoid

53. Bullous Pemphigoid: alternative treatment options such as tetracycline 500mg tds to qds / doxycycline 100mg bd and nicotinamide 500mg tds to qds, this combination anti-inflammatory regime tetracycline/doxycycline + nicotinamide, is only useful in those with limited or localized disease e.g. acral bullous pemphigoid