Discover and read the best of Twitter Threads about #PEMPHIGUS

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It's been ages since I've put out a #dermtwitter #tweetorial, so I thought what better way than to share a diagnosis that was the original motivator for me to become a dermatologist! A 🧵 on:

PEMPHIGUS VEGETANS!

#MedEd #dermatology #medtwitter #FOAMEd @healourskin #pemphigus
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What is Pemphigus Vegetans? This is where breaking down the terms can be super helpful. It's the diagnosis we give when pemphigus has the morphology of vegetative plaques.

A #tweetorial on pemphigus if you need it👇

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Some people think Vegetans occurs when Vulgaris goes untreated. Others think it's just a rare subtype of vulgaris.

Given the clinical findings, the path looks different with pseudoepitheliomatous hyperplasia (but still with a suprabasal split!).

pc:dermatologyadvisor.com/home/decision-…
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Read 12 tweets
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A #dermtwitter #tweetorial on...

#PEMPHIGUS VULGARIS!

Join me for a quick #thread on this autoimmune blistering disorder!

#MedEd #FOAMEd #medtwitter #MedStudentTwitter
2/
Pemphigus vulgaris is where the patient's own antibodies target a Desmosomal protein, which leads to the keratinocytes coming apart.

I describe this to patients as a brick wall, where the mortar holding things together is getting dissolved.

Remember this?👇
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This is contrast to the Pemphigoid group of diseases, that target the hemidesmosome. In other words, remember that:

pemphiguS = Superficial (in the epidermis) (1)
pemphigoiD = Deep (below epidermis) (2)

pemphigus = FLACCID blisters
pemphigoid = TENSE blisters
Read 17 tweets
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#Dermatology #tweetorial time! Let's spend some time on the autoimmune blistering diseases. There are many, so this will be a broad overview of the approach to a the bullous disease patient.
#dermtwitter #FOAMed #medtwitter #medstudenttwitter #MedEd @healourskin pc:@dermnetnz
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The first ? we usually ask: "What is the level of the split?" That helps to distinguish between the #pemphigus group of diseases where the desmosome is involved in the epidermis, and the #pemphigoid group where the hemi-desmosome is involved at the basement membrane zone.
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This correlates with the exam! Higher up in the epidermis means a thinner walled blister that's more fragile. So these are usually flaccid bullae. Deeper down means tense bullae. Photo 1 is pemphigus - see how droopy the bulla is? Vs photo 2 of pemphigoid, which stands up.
Read 17 tweets

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