VisualDx Differential Helps Guide PA to Right Diagnosis and Treatment

A PA at Providence Health shares how VisualDx helped guide her toward the right diagnosis:

I saw an elderly female patient with many urticarial plaques and a few tense blisters. I used VisualDx to review the differential for tense blisters and was able to diagnose and begin treatment for bullous pemphigoid! Thanks VisualDx!

What is bullous pemphigoid?

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease with average onset at around 60 years of age. There is no ethnic or sex predilection.

What should we be aware of when making a diagnosis?

Pruritus is prominent and may precede the appearance of skin lesions.

Urticarial plaques may precede bullae for up to many months or be a persistent manifestation of the disease in some patients, so BP should be considered as the diagnosis in an older patient who presents with itchy urticarial plaques without bullae.

How can we treat this?

Localized disease:

  • High-potency topical corticosteroids or intralesional steroids.

Extensive disease:

  • Topical steroids are one of the more well-validated, underutilized treatments for BP. Efficacy is between 70%-100%, and time to disease control is approximately 2 weeks. Data suggest that strong topical corticosteroids are superior to systemic corticosteroids with regards to relapse rate, complications, and time to response.
  • Systemic steroids should be limited to short-time transitional use in severe disease. Pulse (intravenous) or daily oral steroids can be used.

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