Vesicular and bullous lesions

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

Template:Search infobox 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

Dyshidrotic eczema (pompholyx)
Friction blisters
Herpes Zoster
Herpes Simplex Viruses
Shingles

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

Skin: Tinea Pedis, Vesicular; Vesiculobullous Diseases
Skin: Dyshidrosis, Vesicular; Vesiculobullous Diseases

Skin: Scabies, Vesicular; Vesiculobullous Diseases
Skin: Erythema Multiforme, Vesicular; Vesiculobullous Diseases

Skin: Erythema Multiforme, Vesicular; Vesiculobullous Diseases
Skin: Pityriasis Lichenoides, Vesicular; Vesiculobullous Diseases

Treatment

Acute Pharmacotherapies

HSV-1, HSV-2, HZV

Bullous impetigo

topical mupirocin
systemic antibiotics

Pemphigus

Systemic immunosuppressants

Chronic Pharmacotherapies

SJS/TEN

discontiue offending drug
IVIG
Systemic steroids

Dyshidrotic eczema

high potency topical steroid
heavy emollients

References

↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ 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:

For Patients

Template:WikiDoc Sources

[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

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