Symptoms of Bullous Pemphigoid
Symptoms of Bullous Pemphigoid
The list of signs and symptoms mentioned in various sources
for Bullous Pemphigoid includes the 9
symptoms listed below:
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Medical Books Excerpts
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are available from published medical books
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Medical Books Excerpts
- Dermatitis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Atopic dermatitis:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Scratching the skin causes vasoconstriction and intensifies pruritus, resulting in erythematous, weeping lesions. Eventually, the lesions become scaly and lichenified. Usually, they’re located in areas of flexion and extension, such as the neck, antecubital fossa, popliteal folds, and behind the ears. Patients with atopic dermatitis are prone to unusually severe viral infections, bacterial and fungal skin infections, ocular complications, and allergic contact dermatitis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Dermatitis:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Atopic skin lesions generally begin as erythematous areas on excessively dry skin. In children, such lesions typically appear on the forehead, cheeks, and extensor surfaces of the arms and legs; in adults, at flexion points (antecubital fossa, popliteal area, and neck).
During flare-ups, pruritus and scratching cause edema, crusting, and scaling. Eventually, chronic atopic lesions lead to multiple areas of dry, scaly skin, with white dermatographia, blanching, and lichenification.
Common secondary conditions associated with atopic dermatitis include viral, fungal, or bacterial infections, and ocular disorders.
Because of intense pruritus, the upper eyelid is commonly hyperpigmented and swollen, and a double fold occurs under the lower lid (Morgan-Dennie folds, Morgan folds, Dennie pleats, or Mongolian lines). Atopic cataracts are unusual but may develop between ages 20 and 40.
Kaposi’s varicelliform eruption, a potentially fatal, generalized viral infection, may develop if the patient with atopic dermatitis comes in contact with a person who’s infected with herpes simplex.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Dermatitis:
Signs and symptoms
(Handbook of Diseases)
Atopic skin lesions generally begin as erythematous areas on excessively dry skin. In children, such lesions typically appear on the forehead, cheeks, and extensor surfaces of the arms and legs; in adults, at flexion points (antecubital fossa, popliteal area, and neck).
During flare-ups, pruritus and scratching cause edema, crusting, and scaling. Eventually, chronic atopic lesions lead to multiple areas of dry, scaly skin, with white dermatographia, blanching, and lichenification.
Common secondary conditions associated with atopic dermatitis include viral, fungal, or bacterial infections and ocular disorders.
Because of intense pruritus, the upper eyelid is commonly hyperpigmented and swollen, and a double fold occurs under the lower lid (Morgan’s, Dennie’s, or Mongolian fold). Atopic cataracts are unusual but may develop between the ages of 20 and 40.
Kaposi’s varicelliform eruption (eczema herpeticum), a potentially serious widespread cutaneous viral infection, may develop if the patient comes in contact with a person who is infected with herpes simplex.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Cough - Case 4-2: 7-Week-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Pulmonary vascular resistance determines the extent of the left-to-right shunt.
Pulmonary vascular resistance is elevated at birth and declines to adult levels
over the first week of life. Therefore, with small VSDs, usually no heart
murmur is heard at birth. Most often, the murmur is heard at about 1 to 6 weeks
of age; it is usually holosystolic, harsh, and located along the left sternal
border. Most infants with small VSDs have no significant symptoms and thrive.
In those infants with moderate or large VSDs, symptoms may develop at about 2
weeks of age and can include tachypnea, irritability, diaphoresis or fatigue
with feeding, and failure to thrive. These symptoms develop secondary to
progressive heart failure and pulmonary edema. Not uncommonly, symptoms come to
attention immediately after a respiratory infection, which stresses the infant
's small reserve. With large defects, infants often have a hyperactive precordium
with a palpable thrill. Large VSDs, like small ones, produce an associated
harsh, holosystolic murmur located along the left sternal border.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Cough - Case 4-3: 7-Month-Old Girl:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
The prodromal phase begins with 3 to 5 days of malaise, fever, cough, coryza,
and conjunctivitis. These symptoms increase over the course of the prodromal
phase. Fevers vary from 39.4
° to 40.6°C and usually peak as the exanthem begins. Just before the development of the
exanthem, Koplik
's spots are noted. These are bluish spots on a red base that are found on the
buccal mucosa. Koplik
's spots are pathognomonic of measles. The exanthem begins as Koplik's spots begin to slough. The rash typically begins on the face and then moves in
a caudal direction. The rash is initially erythematous and maculopapular but
then becomes confluent. The rash usually lasts 5 to 7 days.
Other symptoms can include pharyngitis, lymphadenopathy, splenomegaly, diarrhea,
vomiting, and abdominal pain. With typical measles, patients are ill for 7 to
10 days. However, complications can occur and include pneumonia, encephalitis,
myocarditis, pericarditis, appendicitis, and corneal ulcerations. Subacute
sclerosing panencephalitis (SSPE) is an uncommon neurologic complication of
measles infection. SSPE consists of a degenerative central nervous system
process that is associated with a persistent measles infection.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Cough - Case 4-6: 4-Month-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
The incubation period is 1 to 3 weeks. Infection is divided into three stages.
The catarrhal stage begins with symptoms of a mild upper respiratory tract
infection and lasts a few days to 1 week. The paroxysmal stage follows, with
the characteristic inspiratory whoop. Posttussive emesis is common, and fever
is infrequent. The whoop is typically absent in infants, because they are
unable to generate the force needed for this maneuver.
Increased intrathoracic and intraabdominal pressures during coughing may lead to
conjunctival and scleral hemorrhages, petechiae on the upper body, epistaxis,
and retinal hemorrhages. In infancy, apnea is a common complication of
B. pertussis infections. Even young adults can have episodes of laryngospasm. Seizures result
from either hypoxia or hyponatremia due to inappropriate secretion of
antidiuretic hormone.
In most cases, a pertussis infection lasts 6 to 10 weeks, but it is not uncommon
for infants and children to have persistent coughs for 3 to 4 months.
Respiratory distress between paroxysms of coughing suggests superinfection with
various viruses (adenovirus, respiratory syncytial virus, cytomegalovirus) or
bacteria (
S. pneumoniae, S. aureus). Other complications include pneumothorax, encephalopathy, and feeding
difficulties in infancy. The disease is most severe in infants younger than 1
year of age, especially premature infants.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Diarrhea - Case 17-1: 2-Month-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
An inguinal hernia usually manifests as an asymptomatic swelling in the scrotal
or labial area that increases in size with any increase in intraabdominal
pressure, as occurs with crying or straining. Reducible hernias disappear
spontaneously or with minimal pressure. An incarcerated hernia develops when a
loop of bowel becomes trapped, and it is accompanied by severe pain and signs
of bowel obstruction, such as bilious emesis. Strangulation of the herniated
loop of bowel occurs when the blood supply to the bowel is compromised and may
develop within 2 hours after incarceration. Urgent medical attention is
required in cases of incarceration, and emergency surgical intervention may be
necessary in cases of strangulation.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Diarrhea - Case 17-4: 15-Month-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Most pediatric patients with neuroblastoma are diagnosed by 5 years of age, and
most tumors are intraabdominal in location. However, patients older than 1 year
of age have a higher incidence of intrathoracic and cervical tumors, compared
with younger patients. Among children older than 1 year of age, 75% present
with a disseminated, advanced stage of disease and account for a significant
proportion of neuroblastoma-associated mortality. Infants younger than 1 year
of age tend to present with lower-stage disease and have much higher cure
rates. Some of the tumors in this latter group even undergo spontaneous
regression. One percent of patients have no detectable primary tumor. In 35% of
children, neuroblastoma metastases occur to the regional lymph nodes,
qualifying as disseminated disease. Hematogenous spread to bone, bone marrow,
liver, and skin also occurs. Late metastases are seen in the brain and lung.
Patients may present with a large abdominal mass or with respiratory distress
secondary to the intraabdominal mass. Intrathoracic tumors are often
incidentally found. Opsoclonus-myoclonus is an well-defined presenting syndrome
for neuroblastoma. Presentation as severe secretory diarrhea, as in this case,
is known as Verner-Morrison syndrome.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Fever - Case 11-1: 18-Month-Old Girl:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Despite advances in our understanding of the molecular basis for NF1, the
diagnosis remains one that is largely based on clinical criteria. Clinical
diagnosis of NF1 requires the presence of at least two of the seven consensus
criteria stipulated by the National Institutes of Health (NIH) (Table 11-3).
Children with sporadic rather than inherited cases may not meet the NIH
diagnostic criteria until later in life. At 1 year of age, approximately 50% of
individuals with sporadic disease lack two or more of the cardinal clinical
features permitting diagnosis, but by age 8 years, 95% meet NIH criteria.
The most visible features of NF1 are flat, evenly pigmented macules known as café-au-lait spots. These macules, often present at birth, increase in both number
and size over the first few years of life. One or two caf
é-au-lait macules are present in up to 25% of the normal population, but the
presence of six or more macules should raise suspicion for NF1. These macules
are easier to visualize with the use of a Wood
's lamp. Skinfold freckling, another pigmentary change associated with NF1,
usually occurs in the axillae, groin, nape of the neck, or under the chin. By 6
years of age, approximately 80% of children with NF1 demonstrate axillary or
inguinal freckling.
Lisch nodules are benign pigmented hamartomas of the iris that occur in patients
with NF1. These nodules do not interfere with vision. Lisch nodules may not be
apparent in young children, but they are present in more than 95% of adolescent
and adult patients. Detection of Lisch nodules on bedside examination is
challenging, and diagnosis frequently requires a slit-lamp examination by an
experienced ophthalmologist. In contrast to Lisch nodules, optic nerve tumors,
such as optic nerve gliomas, occur primarily in younger children. They are
often associated with asymmetric, noncorrectable vision loss, diminished
peripheral vision and color discrimination, and proptosis.
Subcutaneous or cutaneous (dermal) neurofibromas are rarely seen in young
children but appear during or just before adolescence. Neurofibromas are
present in 48% of 10-year-old patients and 84% of 20-year-old patients.
Cutaneous lesions frequently begin as small papules on the face, scalp, trunk,
and extremities. Deep lesions may be detected only through palpation. These
lesions represent a major cosmetic problem but do not transform into malignant
tumors. In contrast, plexiform neurofibromas surround soft tissue and bone,
causing aberrant growth. Plexiform neurofibromas, present in 30% of patients,
are locally invasive and may undergo malignant transformation. They may be
accompanied by overlying hyperpigmentation or hypertrichosis. Other tumors that
occur with higher frequency in patients with NF1 include pheochromocytomas,
juvenile chronic myeloid leukemia, and rhabdomyosarcomas.
Seizures occur in approximately 4% to 5% of patients with NF1. Seizures may be
generalized or partial. In a study by Korf et al., 22 of 359 NF1 patients
developed seizures. The seizures were most often characterized as
complex-partial (9 patients), febrile (6 patients), or generalized epilepsy (3
patients). Other manifestations of NF1 include learning disabilities, pain,
scoliosis, headaches, stroke, and bowel or bladder complications (secondary to
pelvic plexiform neurofibromas).
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Fever - Case 11-4: 7-Month-Old Girl:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Most patients with AIN in infancy suffer from mild infections such as otitis
media, gastroenteritis, lymphadenitis, superficial skin infections, or upper
respiratory tract infections. In one series, 6 (23%) of 26 girls developed
cellulitis of the labia majora, and 3 of these 6 infections were caused by
P. aeruginosa. Approximately 10% to 15% of patients have serious infections, including
pneumonia, sepsis, or meningitis. In approximately 10% of children, the
diagnosis is suspected only after a routine complete blood count reveals
neutropenia.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Jaundice - Case 15-1: 14-Day-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Classic galactosemia is an autosomal recessive disease. If not recognized and
treated, it can be fatal in the neonatal period. Some of the more common
presenting clinical signs have already been discussed (jaundice, hepatomegaly,
vomiting, and encephalopathy); more fulminant clinical courses may represent
superimposed bacterial sepsis. Among the laboratory findings seen with classic
galactosemia are conjugated (or combined) hyperbilirubinemia, liver function
test and coagulation study abnormalities, elevations of serum and urine amino
acids, and a renal tubulopathy with galactosuria, glycosuria, proteinuria, and
metabolic acidosis. Not surprisingly, plasma galactose and erythrocyte
galactose-1-phosphate levels are also elevated.
Disappointingly, even galactosemic children whose diets were restricted very
early are at increased risk for developmental delays and learning disabilities,
compared with their healthy counterparts. Although many children have IQs in
the normal range, cognitive, speech, and motor impairments are, nevertheless,
more common. Longer delays before initial diagnosis and treatment of
galactosemia correlate with worse neurodevelopmental sequelae.
Hypergonadotropic hypogonadism is often observed in girls with galactosemia, and
most are infertile as adults. Galactosemic males demonstrate normal puberty and
fertility.
The gene for the galactose-1-phosphate uridyl transferase enzyme has been
localized to chromosome 9, and multiple variations at that locus have been
described. Some African-Americans with galactosemia have a milder clinical
course because of a different transferase variant. Still another variant, known
as the Duarte variant, is usually clinically insignificant. Prenatal diagnosis
of galactosemia is available.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Jaundice - Case 15-3: 2-Month-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Prolonged neonatal jaundice may be the first sign of congenital hypothyroidism
and hypopituitarism. Feeding difficulties, apnea, noisy breathing, and overall
sluggishness are other common manifestations. Physical findings specifically
attributable to hypothyroidism can include a relatively large head, anterior
fontanel, tongue, and abdomen; umbilical hernia; edema; and a
lower-than-expected pulse and temperature. Mental and physical development
become increasingly retarded over time when hypothyroidism goes undetected and
uncorrected.
Among the physical findings that may be detected in patients with congenital
hypopituitarism are micropenis, midline craniofacial defects (e.g., cleft lip
or palate), a single central incisor, and signs of hypoglycemia or
hypocortisolism, such as lethargy or apnea. The possibility of septo-optic
dysplasia should be considered whenever congenital hypopituitarism is
diagnosed. In addition to the neuroendocrine deficiency, these patients have
optic nerve hypoplasia and agenesis of the septum pellucidum.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Jaundice - Case 15-4: 6-Week-Old Girl:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Infants with biliary atresia often present in the first 2 to 6 weeks of life
with acholic stools, hepatomegaly, and jaundice. Over time the urine darkens,
the jaundice persists, the liver grows (as bile stasis worsens), and even the
spleen may enlarge. In the early weeks and months, these children often appear
well and have unremarkable medical histories. If the disease goes untreated,
malnutrition, growth retardation, and liver dysfunction emerge. Portal
hypertension, coagulopathy, and hypersplenism may develop. In untreated
patients, average expected survival time is about 1 year.
In this case, the baby presented with a direct hyperbilirubinemia but also a
mild elevation of liver enzymes suggestive of hepatocellular injury. This is
common in EHBA, although these findings may also be seen with neonatal
hepatitis or other disease entities, and indeed there can be considerable
overlap in clinical and laboratory findings among the various etiologies of
conjugated hyperbilirubinemia. The complete blood count was not suggestive of
acute infection, and the urinalysis appeared benign. The absence of
urobilinogen is actually consistent with an obstructive cholestasis, because
its formation requires entry of conjugated bilirubin into the intestine for
degradation by gut bacteria. The presentation of a jaundiced but otherwise
well-appearing 6-week-old infant with conjugated hyperbilirubinemia prompted an
immediate search for an obstructive process, and hepatic scintigraphy strongly
suggested the diagnosis that was confirmed by intraoperative cholangiogram.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Jaundice - Case 15-6: 5-Week-Old Girl:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Alagille syndrome typically manifests as cholestasis in the first months of
life. Clinical and laboratory findings of the liver disease include jaundice,
acholic stools, pruritus, growth failure, conjugated hyperbilirubinemia, and
elevations of hepatic enzymes. Most patients with Alagille syndrome also have
heart murmurs, and the underlying heart conditions range in severity from
benign (e.g., mild peripheral pulmonary stenosis) to complex disease requiring
surgery (e.g. tetralogy of Fallot). The most common ocular finding in Alagille
syndrome is posterior embryotoxon, a dysgenesis of the anterior chamber of the
eye (best seen on slit-lamp examination) in which there is prominence of
Schwalbe
's ring, a ridge of collagenous fibers surrounding the periphery of Descemet's membrane.
Patients with Alagille syndrome often have a distinctive facies that may be
detectable as early as infancy. Features can include a triangular face with a
broad forehead and pointed chin, deeply set eyes, and a long nose with a
bulbous tip. Xanthomas are another physical finding common to patients with
Alagille syndrome.
Other problems associated with Alagille syndrome include renal anomalies (both
structural and functional), pancreatic insufficiency, intracranial hemorrhage,
and cognitive impairments. Assessments of renal function and anatomy (i.e.,
ultrasonography) should be performed. The patient presented in this case, for
example, demonstrated slow but spontaneous improvement in her renal function
and never required alkali supplementation.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Pallor - Case 10-1: 3-Week-Old Boy:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
Pallor caused by anemia in the early months of life characterizes this form of
anemia. About one third of patients have an associated finding. There are many
associated anomalies, including characteristic facies, thumb anomalies, short
stature, eye abnormalities including glaucoma, renal anomalies, hypogonads,
skeletal anomalies, congenital heart disease, and mental retardation. There is
a wide range of involvement. The current median survival rate is 45 years. Some
patients progress to full aplastic anemia, and about 5% develop leukemia or
myelodysplasia.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Pallor - Case 10-2: 12-Month-Old Girl:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
The clinical examination in children with mild iron deficiency is usually
normal. With moderate or severe iron deficiency, the findings may be similar to
those seen with other causes of anemia, including fatigue and pallor. If the
anemia develops gradually, as in the child presented here, immediate family
members may not notice changes in pigmentation. Other findings may include
pica, the compulsive consumption of nonnutritive substances such as soil or
ice. Long-standing iron deficiency may lead to angular stomatitis and
glossitis. Softening of the fingernails leads to concave deformities
descriptively termed
“spooning” (koilonychia).
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Rash - Case 9-2: 7-Week-Old Girl:
IV. Clinical Presentation
(Pediatric Complaints and Diagnostic Dilemmas)
The diagnosis of child abuse must be considered in all cases in which a child's injuries cannot be explained and there is a discrepancy between the physical
findings and the history. In a study of bruises occurring in children 6 to 9
months of age, Carpenter found that all accidentally acquired bruises were on
the front of the body and that no bruise was greater than 1 cm. In a larger
study of children, Sugar et al. demonstrated that only 2.2% of bruises occurred
in infants who did not walk or cruise, and only 0.6% occurred in children
younger than 6 months of age. In cases that did not involve abuse, bruises were
small, few, and located on bony prominences. Typical accidental bruises involve
the skin overlying bony prominences such as the anterior tibia, knees, elbows,
forehead, and dorsum of the hands. Parents can usually give explanations for
how the bruises occurred, unlike these parents.
The shape of the bruise may also suggest intentional harm. Finger and thumb
prints may be found on the arms where a child has been forcefully held. A blunt
instrument often leaves a bruise that resembles the shape of the instrument.
Loop-shaped marks are caused by a folded extension cord or rope.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Bullous Pemphigoid as a Cause of Symptoms or Medical Conditions
When considering symptoms of Bullous Pemphigoid, it is also important to consider Bullous Pemphigoid as a possible cause of other medical conditions.
The Disease Database lists the following medical conditions that Bullous Pemphigoid may cause:
- (Source - Diseases Database)
Bullous Pemphigoid as a symptom:
For a more detailed analysis of Bullous Pemphigoid as a symptom, including causes, drug side effect causes, and drug interaction causes, please see our Symptom Center information for Bullous Pemphigoid.
Bullous Pemphigoid: Onset and Incubation
Onset of Bullous Pemphigoid: usually after 60 years of age
Medical articles and books on symptoms:
These general reference articles may be of interest
in relation to medical signs and symptoms of disease in general:
Full list of premium articles on symptoms and diagnosis
About signs and symptoms of Bullous Pemphigoid:
The symptom information on this page
attempts to provide a list of some possible signs and symptoms of Bullous Pemphigoid.
This signs and symptoms information for Bullous Pemphigoid has been gathered from various sources,
may not be fully accurate,
and may not be the full list of Bullous Pemphigoid signs or Bullous Pemphigoid symptoms.
Furthermore, signs and symptoms of Bullous Pemphigoid may vary on an individual basis for each patient.
Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they
are indeed Bullous Pemphigoid symptoms.
The father of television personality Linda Dano experienced years of mental deterioration before he was diagnosed with Alzheimer's disease. Hear...
People with early-stage Alzheimer's disease know that they will have trouble remembering things. But there are a variety of techniques that can...
Allen Willner was diagnosed with Alzheimer's disease early in the disease process. With medication and the care of his wife, he's slowing the...
People with early Alzheimer's disease know that the condition gets progressively worse over time. Learn how some medications help to stabilize...
See full list of 16 related videos
» Next page: Diagnostic Tests for Bullous Pemphigoid
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