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.

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

• bullous pemphigoid
• pemphigus vulgaris
• porphyria cutanea tarda

• Polymorphous light eruption
• Stevens-Johnson Syndrome
• Toxic epidermal necrolysis (TEN)
• Varicella

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

• acyclovir
• famciclovir

Bullous impetigo

• topical mupirocin
• systemic antibiotics

• erythromycin
• cephalexin

Pemphigus

• Systemic immunosuppressants

• prednisone
• cyclosporin
• azathioprine

Chronic Pharmacotherapies

SJS/TEN

• discontiue offending drug
• IVIG
• Systemic steroids

Dyshidrotic eczema

• high potency topical steroid
• heavy emollients

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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