Other Vesiculobullous Diseases

Published on 05/03/2015 by admin

Filed under Dermatology

Last modified 05/03/2015

Print this page

This article have been viewed 1323 times

27

Other Vesiculobullous Diseases

There are a number of disorders that can present with vesicles and bullae, including exaggerated insect bite reactions (see Chapter 20), autoimmune and inherited blistering diseases (see Chapters 23–26), porphyrias (see Chapter 41), the Stevens–Johnson syndrome–toxic epidermal necrolysis spectrum (see Chapter 16), and phototoxicity, from sunburn to phototoxic drug reactions (e.g. due to doxycycline). This chapter examines a miscellaneous group of disorders, several of which favor the lower extremities, whereas Chapter 28 reviews vesiculobullous diseases in newborns and infants.

Friction Blisters

• Most commonly develop on the heels, soles, and palms; the blister develops within the epidermis, contains clear or hemorrhagic fluid (‘blood blister’), and heals spontaneously without scarring.

• Due to repeated friction (e.g. prolonged walking in ill-fitting shoes) and repetitive actions (e.g. raking leaves).

• DDx: if exaggerated response, can consider inherited blistering disease, in particular the localized form of epidermolysis bullosa simplex (see Chapter 26).

• Rx: if significant fluid accumulation, drainage of fluid can relieve pressure; the roof of the blister should be left in place to act as a ‘natural Band-Aid’; secondary soft tissue infection is unusual in immunocompetent individuals.

Edema Bullae (Edema Blisters)

• The bullae are bland (i.e. non-inflammatory), initially tense, and may reach several centimeters in diameter; they arise within areas of significant edema and contain sterile, usually clear but occasionally blood-tinged, fluid.

• The most common location is the distal lower extremities, often in the setting of an acute exacerbation of chronic edema in an elderly patient; in patients with anasarca and those who are bedridden, the distribution can be more widespread (Fig. 27.1).

Fig. 27.1

Buy Membership for Dermatology Category to continue reading. Learn more here

Related

Dermatology Essentials E- Book