Vesicular and bullous lesions

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Vesicular and bullous lesions
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Skin: Dyshidrosis, Vesicular; Vesiculobullous Diseases

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Vesicular and bullous lesions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Overview

To avoid missing serious causes, Vesicular and Bullous lesions must be approached systemically.

Primarily, the decision as to whether lesions are focal or diffuse is made, lesion history is taken, system review, and a focused physical exam. Non obvious lesions should be referred to a dermatologist.

Differential Diagnosis

In alphabetical order. [1] [2]

Localized

  • Allergic contact Dermatitis
  • Bullous impetigo
  • Bites from various insects
  • Burns
  • Diabetics
  • may develop bollous on the legs

Diffuse

  • Blistering diseases

Other

Skin biopsy if PCT, pemphigus, and pemphigoid is seen

Laboratory Findings

  • Obtain HSV-2 culture if suspect.
  • IgM & IgG antibodies will also contain HSV-2

Diagnostic Findings

Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology





Treatment

Acute Pharmacotherapies

HSV-1, HSV-2, HZV

Bullous impetigo

Pemphigus

  • Systemic immunosuppressants

Chronic Pharmacotherapies

SJS/TEN

  • discontiue offending drug
  • IVIG
  • Systemic steroids

Dyshidrotic eczema

  • high potency topical steroid
  • heavy emollients

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Acknowledgements

The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

List of contributors:


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