Vesicular and bullous lesions

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

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
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