Updates on the Diagnosis of Blistering Diseases, with Donna Culton, MD, PhD

The Maui Derm NP+PA Fall 2024 conference featured a talk by Donna Culton, MD, PhD, titled ‘Blistering Diseases: What’s the Diagnosis,’ in which Culton presented a set of blistering disease cases designed to challenge diagnostic and therapeutic acumen of attendees.

Culton is a professor of dermatology at the University of North Carolina at Chapel Hill. In an interview at the conference, the HCPLive editorial team spoke with her about the talk’s highlights, delving into the difficulties clinicians, physician assistants, and nurse practitioners face when helping patients with conditions like pemphigus and bullous pemphigoid.

“If you don't see (these conditions) very often, sometimes it's hard to keep up with, so I would say the number 1 challenge is making sure that you have a confirmed diagnosis of these rare diseases and being able to recognize atypical presentations,” Culton said. “Many of the cases that I present and use for teaching points are really that there are more and more atypical clinical presentations.”

Culton explained that more and more frequently those in dermatology are recognizing that both pemphigus and especially pemphigoid can present with non-blistering clinical findings. This can make a diagnosis challenging for an already-uncommon disease.

“Certainly, bullous pemphigoid is the most common autoimmune blistering disorder,” Culton said. “That typically presents an older patient population, so many dermatologists will have a few patients that they're treating with bullous pemphigoid. Again, what's new in bullous pemphigoid Is this non-bullous presentation that we used to kind of think of as a prodromal phase…We're all taught that in residency, and the implication is that all those patients are going to go on to become blistering patients. But it is not true.”

Those in the field of dermatology are beginning to realize that not every urticarial pemphigoid patient goes on to have blisters, suggesting that it may not be a prodrome and it may be the way that some patients display their pemphigoid.

To find out more about this subject, view the full interview segment posted above this summary. View our conference coverage here.

The quotes contained here were edited for clarity. Culton reported being a principal investigator for Lilly and receiving royalties from UpToDate.