Page 1822 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 129: Dermatologic Conditions 1291

FIGURE 129-15. Pemphigus vulgaris (PV). A. Multiple erosions on the trunk. B. Crusted
erosions and a few intact, but flaccid bullae noted on the lower abdomen. (Used with permis-
sion of Dr Aisha Sethi.)

split with application of pressure to small intact bullae) is a characteristic
feature. Blisters may occur anywhere on the body, with a predilection
for the trunk, groin, scalp, and face. Mucous membrane involvement is
characteristic. The oral mucosa is involved in more than 95% of patients
70
and is the initial manifestation in up to 70%. PV occurs primarily in the

FIGURE 129-14. Drug reaction with eosinophilia and systemic symptoms (DRESS).
A. Edema of the face. B, C Coalescing, erythematous papules on the palms and soles.
Desquamation of the soles is also noted. (Used with permission of Dr Aisha Sethi.)

PV is characterized by flaccid bullae on normal or slightly erythema-
tous skin. The bullae rupture easily, leaving superficial and crusted
erosions. Intact bullae are rarely seen due to their superficial location. FIGURE 129-16. Paraneoplastic pemphigus. Mucocutaneous erosions with hemor-
The presence of Nikolsky sign (lateral extension of an intraepidermal rhagic crust on the face. (Used with permission of Dr Aisha Sethi.)

section11.indd 1291 1/19/2015 10:54:04 AM