AUTOIMMUNE BULLOUS DISEASES

Patients with autoimmune bullous diseases are occasionally encountered in primary care practice, usually in middle-aged and older patients. The differential diagnosis includes nonimmune causes, such as contact dermatitis, infections and bullous reactions to drugs or insect bites. An autoimmune blistering disease may be distinguished by the age of t he patient when the disease first appears, the morphology and distribu tion of the lesions and the presence or absence of mucosal lesions and scarring. Because the clinical presentations of blistering disorders are often similar, special immunofluorescence tests are used to confir m the specific diagnosis. Since diagnosis and management of an autoimm une bullous disease may involve systems other than the skin, coordinat ion by the primary care physician is crucial.