Review Question - QID 211090

A 65-year-old woman is admitted to the hospital for a widespread rash. She reports that she started getting blisters about 10 days ago. The rash began on her trunk and now is also affecting her arms. She also complains that she is “itchy all over.” She denies any lesions in her mouth or genitalia. She denies fever, headache, vision changes, eye pain, abdominal discomfort, or dysuria. She had breast cancer treated with radical mastectomy, radiation, and chemotherapy 4 years ago. She was diagnosed with Parkinson disease 1 month ago. Her medical history is also significant for osteoporosis. She currently takes carbidopa-levodopa, amantadine, and zoledronate. She denies tobacco, alcohol, or recreational drug use. She is an avid rose gardener after recently retiring as a bank teller. She also states that she helps babysit her granddaughter on the weekends, whose daycare had a recent outbreak of impetigo. She denies recent travel. The patient’s temperature is 99°F (37.2°C), blood pressure is 110/70 mmHg, pulse is 83/min, and respirations are 12/min. On physical examination, there are several 1-3 cm bullae over bilateral upper extremities. There are similar lesions on the trunk and abdomen. When blunt pressure is placed on one of the bullae, the skin does not slough. A biopsy is obtained and the direct immunofluorescence is shown in Figure A. In addition to wound care, which of the following is the most appropriate management for the patient’s condition?