1. BULLOUS DISEASES OF SKIN
WEL COME TO
SEMINAR ON
BULLOUS DISEASES OF SKIN

2. CASE HISTORY  Age : About 25 year  Sex : Female
NAME : MARJINA BEGUM
 Age : About 25 year
 Sex : Female
 Marital Status: Married
 Occupation : House wife.

3. Address :. Vill : Kujghar,. Post : Kujghar,P. S. : Sadar,
Address : Vill : Kujghar, Post : Kujghar,P.S.: Sadar, Dist : Jamalpur.  Date of Admission:  Date of Examination:

4. CHIEF COMPLAINTS
 Diffuse painful blisters & crusted lesions over scalp, face, trunk, upper extrimities & groin.For about 1½ month. A few small blisters in mouth cavity For 7 days.

5. H/O PRESENT ILLNESS
The patient states that she was all right about six months back. Then she developed a few blisters with itching at lower part of back of Lt painful blisters

6. side. Subsequently after 4 months she developed various sizedassociated with itching at her chest, back, upper extrimities, scalp, face, groin & a few painful lesions is oral mucous membrane which became crusted,

7. With above complaints she was admitted in Mymensingh Medical College Hospital for proper management. exfoliative, reddened with moist surface

8. H/O PAST ILLNESS. Nothing contributory.
Personal History: Married for 4 years.
No issue.
Menstruation : Regular.
Habitchewing of battle
nut +

9. family members suffered from any such notable disease.
 Family History: No any of her
family members
suffered from any
such notable disease.

10.  Treatment History: Patient was admitted with complaint mentioned in MMCH on & was treated with long acting steroid triamcinolone acetonide parenterally & was improved.

11. GENERAL EXAMINATION.  Appearance : Ill looking.
 Body build : Average.
 Anaemia
 Jaundice Absent.
 Cyanosis

12.  Oedema
 Dehydration
 Clubbing
 Koilonychia
 Hair
 Nail
Absent
Absent
Normal

13.  Pulse : 86/min/reg/mod.
 B.P : 120/35mm of Hg.
 Temp : Normal
 Respiration : 14/min.
 Neck veins : Not engorged.
 Lymph Node : Not palpable.

14. EXAMINATION OF INTEGUMENTARY SYSTEM.
 Inspection Vesicles & bulla on
scalp, face, chest, back, upper extrimities, groin, some on normal skin & some are erythomatous based.

15. Crust & erosions with. scaling in some areas &
Crust & erosions with scaling in some areas & superfical ulceration in oral cavity.

16.  Palpation : Vesicles & bullae are flacid, tenderness present
NIKOLSKY Sign Present.Bulla – spread plenomenon (The Asboe- Hansen sign) – Present.

17. EXAMINATION OF OTHER SYSTEM :
NAD except a few oral mucosal
lesions.

18. SALIENT FEATURES.
Marjina Begum, Age about 25 years of vill Kujghar, Jamalpur was admitted in MMCH on with complaints of progressive development of painful blisters. Crust, erosions & exfoliative lesions associated with itching

19. over scalp, face, trunk, upper arms, groin & a few small painful blisters in oral cavity. Examination shows flaccid & vesicles, Bullae, crusted & exfoliative lesions with erythomatous base at the mentioned sites. The lesions are

20. Nikolsky sign – Present Bulla – Spread Phenomenon – Present.
tender, moist with malodourous condition & a few superficial erosions in oral mucous membrane.
Nikolsky sign – Present
Bulla – Spread Phenomenon – Present.

21. PROVISIONAL DIAGNOSIS.
 Pemphigus foliaceous.
 D/D. : Pemphigus Vulguris.
Pemphigus vegetans.
Bullous Pemphigoid.
SSSS
Cicatrical Pemphigoid.
Stevens johnson syndorme & TEN.

22. INVESTIGATION.  Skin biopsy for Histopathology & IF test.
 Blood for TC DC Hb% ESR /cmm. N-62%, L-32%,
M-02%, E-0%, Hb% %,ESR- 10mm/1st hour.

23.  Random blood suger.- 103mg/100 ml.
 Urine for R/E NAD
 Blood Urea mg/100ml.
 Serum creatinine mg/100ml.

24. BIOPSY FOR HISTOPATHOLOGY :
 Finding : Pemphigus compatible with pemphigus foliaceous.
CONFIRMATORY DIAGNOSIS.
 Pemphigus foliaceous.

25. TREATMENT.
 Inj. - TRIAMCINOLONE ACETONID 1AMP I/M stat and 1amp on 3rd day & 1 amp on 7th day.
 Tab. - Prednisolon -80mg/day.
 Tab. - Neotack (150mg) daily.

26. TREATMENT(Contd).  Cap. - Sefradine (500mg)1+1+1+1 daily.
 Tab. - Alatrol daily.
 Potash wash - daily.1% Silver sulphadiazine ointment -
daily.

27. SALIENT FEATURE.
Mr. Sumon Das, son of Dr. Kanu Das, aged 29 years hailing form Jamalpur was admitted in MMCH, Cabin-7 on 28th November,2005. He was referred to skin & VD OPD on 30th Nov. 05 with the complaints of exfoliation of

28. skin with generalized mild itching for 20 days, a known case of hypothyroidism due to thyroidectomy 3 months back & bronchial asthma from childhood. On examination we found extensive scaling all over the skin with erythema

29. and itching, mild leg oedema & puffy face
and itching, mild leg oedema & puffy face. Pt’s pulse was 96/min, BP= 120/65 mm of Hg, temp. = F, lungs, heart & urinary output – normal. There was no mucous membrane and nail changes. Pt. also complaints of

30. chilling & gave H/O taking tab
chilling & gave H/O taking tab. Ibuprofen 20 days back and also paracetamol & azithromycin. With these above features our diagnosis is drug induced exfoliative dermatitis.