Vesiculobullous reaction pattern

Published on 08/03/2015 by admin

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6 Vesiculobullous Reaction Pattern

Intracorneal and subcorneal blisters 90

Bullous impetigo 90
Staphylococcal “scalded skin” syndrome 91
Dermatophytosis 91
Pemphigus foliaceus 92
Endemic pemphigus foliaceus 92
Pemphigus erythematosus 93
Herpetiform pemphigus 93
Subcorneal pustular dermatosis 93
IgA pemphigus 94
Infantile acropustulosis 94
Erythema toxicum neonatorum 95
Transient neonatal pustular melanosis 96
Acute generalized exanthematous pustulosis 97
Miliaria crystallina 98

Intraepidermal blisters 98

Spongiotic blistering disease 98
Palmoplantar pustulosis 98
Amicrobial pustulosis associated with autoimmune disease 98
Viral blistering diseases 99
Friction blister 99

Suprabasilar blister 100

Pemphigus vulgaris 100
Pemphigus vegetans 101
Paraneoplastic pemphigus 102
Hailey-Hailey disease 103
Darier’s disease 103
Grover’s disease 104
Acantholytic solar keratosis 104

Subepidermal blisters with little inflammation 105

Epidermolysis bullosa overall 105
Epidermolysis bullosa simplex 105
Junctional epidermolysis bullosa 106
Dystrophic (dermolytic) epidermolysis bullosa 107
Other inherited BMZ bullous disorders 107
Epidermolysis bullosa acquisita 108
Porphyria cutanea tarda 109
Bullous pemphigoid 110
Burns and cryotherapy 111
Toxic epidermal necrolysis 111
Suction blisters 112
Blisters overlying scars 112
Bullous solar elastosis 112
Bullous amyloidosis 112
Bullosis diabeticorum 112
Bullous drug reaction 112
Kindler’s syndrome 113

Subepidermal blisters with lymphocytes 113

Erythema multiforme 113
Paraneoplastic pemphigus 114
Fixed drug eruptions 115
Lichen sclerosus et atrophicus 115
Lichen planus pemphigoides 116
Bullous lichen planus 117
Polymorphic light eruption 118
Bullous fungal infection 118
Dermal allergic contact dermatitis 118
Bullous leprosy 118
Bullous mycosis fungoides 119

Subepidermal blisters with eosinophils 120

Bullous pemphigoid 120
Bullous pemphigoid, urticarial stage 121
Pemphigoid gestationis 122
Bullous arthropod bites 123
Bullous drug reactions 123
Epidermolysis bullosa 123

Subepidermal blisters with neutrophils 124

Dermatitis herpetiformis 124
Linear IgA bullous dermatosis 125
Cicatricial pemphigoid 126
Ocular cicatricial pemphigoid 126
Localized cicatricial pemphigoid 127
Deep lamina lucida (anti-p105) pemphigoid 127
Anti-P200 pemphigoid 127
Bullous urticaria 127
Bullous acute vasculitis 127
Bullous lupus erythematosus 128
Erysipelas 129
Sweet’s syndrome 129
Epidermolysis bullosa acquisita 130

Subepidermal blisters with mast cells 130

Bullous mastocytosis 130

Miscellaneous blistering diseases 131

Coma blister 131

Notes on immunofluorescence 132
Table of major bullous disorders and immunofluorescence results 132

Vesiculobullous reaction pattern

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Bullous disorders along the basement membrane zone (BMZ)

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Notes on immunofluorescence (IF)

• Biopsy placed in Michel’s solution (contains ammonium sulfate)
• DIF = detect tissue-bound immunoreactant, while indirect IF = detect circulating autoantibodies
• Usually use fluorescein isothiocyanate to fluoresce = absorbs at 490–495 nm (blue) and peak emission at 510–517 nm (green color)

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6 Vesiculobullous Reaction Pattern

Intracorneal and subcorneal blisters 90

Bullous impetigo 90
Staphylococcal “scalded skin” syndrome 91
Dermatophytosis 91
Pemphigus foliaceus 92
Endemic pemphigus foliaceus 92
Pemphigus erythematosus 93
Herpetiform pemphigus 93
Subcorneal pustular dermatosis 93
IgA pemphigus 94
Infantile acropustulosis 94
Erythema toxicum neonatorum 95
Transient neonatal pustular melanosis 96
Acute generalized exanthematous pustulosis 97
Miliaria crystallina 98

Intraepidermal blisters 98

Spongiotic blistering disease 98
Palmoplantar pustulosis 98
Amicrobial pustulosis associated with autoimmune disease 98
Viral blistering diseases 99
Friction blister 99

Suprabasilar blister 100

Pemphigus vulgaris 100
Pemphigus vegetans 101
Paraneoplastic pemphigus 102
Hailey-Hailey disease 103
Darier’s disease 103
Grover’s disease 104
Acantholytic solar keratosis 104

Subepidermal blisters with little inflammation 105

Epidermolysis bullosa overall 105
Epidermolysis bullosa simplex 105
Junctional epidermolysis bullosa 106
Dystrophic (dermolytic) epidermolysis bullosa 107
Other inherited BMZ bullous disorders 107
Epidermolysis bullosa acquisita 108
Porphyria cutanea tarda 109
Bullous pemphigoid 110
Burns and cryotherapy 111
Toxic epidermal necrolysis 111
Suction blisters 112
Blisters overlying scars 112
Bullous solar elastosis 112
Bullous amyloidosis 112
Bullosis diabeticorum 112
Bullous drug reaction 112
Kindler’s syndrome 113

Subepidermal blisters with lymphocytes 113

Erythema multiforme 113
Paraneoplastic pemphigus 114
Fixed drug eruptions 115
Lichen sclerosus et atrophicus 115
Lichen planus pemphigoides 116
Bullous lichen planus 117
Polymorphic light eruption 118
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