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S6C1 - VESICULO-BULLOUS DISORDERS (tier 1)
SECTION 6
Chapter 1 (HOME)
Richard J. Reed, M.D., New Orleans, LA
You are at Section 6, Chapter 1, HOME, a section devoted to some of the vesiculo-bullous disorders. In moving about this section, the same conventions apply as for
the preceding sections (assuming that you have reached this section after having read the directions for moving about one of the earlier sections). This is a three tiered site with HOME at the first tier, multiple
textual chapters at the second tier, and a multiple pictorials chapters at the third tier. Clusters of navigation bars to the left and at the end of all the pages (providing access either to chapters or sections)
will allow the reader to move about this section, or to navigation to other sections. The first (blue) cluster provides access to HOME and to all the textual chapters at level 2. The second (
beige) cluster provides access to all the pictorials at level 3, and to relevant parent textual chapters at level 2. At the end of the page, a mauve cluster provides access to the other sections of this site. Also at the end of the page, a cluster of two green
navigation bars provides access to two web sites. Items in the clusters to the left that are marked with an “-X” are parent textual chapters for one or more chapters of pictorials.
There are three other navigation bars at the end of each chapter. A click on one of these three bars takes the reader to the “NEXT”
chapter in sequence along the tier that the reader has in view (with exception of Home which is a single chapter). At the pictorial level, this bar will provide access only to the children of a parent textual chapter; to access children of other parent textual chapters along the 3rd tier, the reader should search out the next item ending in the suffix “-X” in the
beige
cluster in the MASTERBORDER; a click on the next pictorial item in the descending list will then take the reader to the next group of pictorials; the reader can then maneuver about with the NEXT
page bar (sequence) bar at the end of the page; once he has exhausted all the options related to a parent, he can then seek out the next parent textual bar in the beige
cluster. A “BACK” bar at the end of the page will take the reader to the previous page, in reverse sequence, and at the same level as in the reader’s view at the time of his “click.” Both the NEXT
and the BACK bars are spatially oriented. To move back in a temporal sequence, the reader should use his browser’s BACK
button. A click on the third navigation bar at the end of the page takes the reader “UP”
to the next tier; if the reader is at tier 3 (pictorials), a click will take the reader to a relevant parent textual page at tier 2; if the reader is at tier 2 (a textual page), a click will take him HOME. A label at the end of a chapter identifies the level of the item in view for tiers 1 & 2.
An IMAGE MAP provides direct access to the pictorials. The pictorials are listed by an underlined caption number and by diagnosis.
Much of the material on cicatricial pemphigoid was collected by a young Lee Nesbitt; it was never published.
Pemphigus and Sub-epidermal Vesicular Disorders
The vesiculo-bullous disorders include intra-epidermal variants and sub-epidermal variants. Some of the disorders might be characterized as dermolytic bullous
disorders. The sub-epidermal vesicular disorders are mostly characterized as a sequelae in reaction to immune deposits at the level of the basement membrane. In this approach, associated cytopathic changes affecting
basal keratinocytes are usually ignored. In some forms of epidermolysis bullosa, but not necessarily the subepidermal variants, cytopathic changes are given recognition. Some “subepidermal vesiculo-bullous lesions”
are actually dermolytic in the papillary dermis; in these disorders, a thin portion of the papillary dermis, beneath the basement membrane, remains attached to the epidermis; the roof of the defect is epidermis,
basement membrane, and a thin portion of the papillary dermis.
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