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vesiculobullous dermatitis
Etiology: (Differential diagnosis)
1) subcorneal (beneath the stratum corneum) vesicles
a) bullous impetigo
b) Staphylococcal scalded skin syndrome
c) miliaria
d) subcorneal pustular dermatosis
2) spongiotic blisters (inter epithelial cell edema)
a) allergic contact dermatitis
b) stasis dermatitis
c) irritant dermatitis
d) superficial fungal infections
3) ballooning degeneration of epidermal cells
a) Herpes simplex
b) Herpes zoster (shingles & chickenpox)
4) acantholytic blisters
a) pemphigus vulgaris
b) pemphigus foliaceus
c) paraneoplastic pemphigus
5) basement membrane blisters
a) bullous pemphigoid
b) cicatricial pemphigoid
c) dermatitis herpetiformis
d) epidermolysis bullosa aquisita
e) toxic epidermal necrolysis
6) other
a) linear IgA bullous dermatosis (IgA pemphigus)
b) Herpes (pemphigoid) gestationis
c) bullous lupus erythematosus
d) mucocutaneous vesiculobullous dermatitis
- lichenoid dermatitis (lichen planus) [4]
Laboratory:
1) skin biopsy
a) light microscopy
- intact vesicle or blister edge
b) direct immunofluorescence
1] erythematous area adjacent to blister
2] allows for identification of antibody deposition
a] dermatitis herpetiformis
b] pemphigus
c] bullous pemphigoid
2) serology may be helpful with IgA pemphigus
3) see ARUP consult [3]
Management:
- varies with etiology
- systemic glucocorticoids
- other immunosuppressive agents
- azathioprine
- methotrexate
- cyclophosphamide
- mycophenolate
- successive or multiple agents are often needed
- treatment for months to years is usual
Interactions
disease interactions
Related
bulla; bleb
vesicular dermatitis
vesicular lesion; blister
Specific
autoimmune bullous disease (... pemphigus, bullous pemphigoid)
chronic bullous disease of childhood
dermatitis herpetiformis; Duhring-Brocq disease
dyshidrotic eczematous dermatitis; pompholyx
epidermolysis bullosa aquisita
erythema multiforme
Herpes (pemphigoid) gestationis
impetigo
linear IgA disease
mucocutaneous vesiculobullous dermatitis
porphyria cutanea tarda (PCT)
transient acantholytic dermatosis (Grover's disease)
General
dermatitis
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18.
American College of Physicians, Philadelphia 1998, 2012, 2018.
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 320
- ARUP Consult: Epithelial Antibody-Associated Immunobullous Diseases Testing
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/immunobullous-skin-diseases-screening
- Epithelial Antibody-Associated Immunobullous Diseases Testing Algorithm
https://arupconsult.com/algorithm/immunobullous-skin-diseases-testing-algorithm
- Immunobullous Diseases Testing Algorithm - Neoplastic Disease
https://arupconsult.com/algorithm/immunobullous-diseases-testing-algorithm-neoplastic-disease
- Immunobullous Diseases Testing Algorithm - Pregnancy
https://arupconsult.com/algorithm/immunobullous-disease-testing-algorithm-pregnancy
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013
- Habbab KM, Moles DR, Porter SR.
Potential oral manifestations of cardiovascular drugs.
Oral Dis. 2010 Nov;16(8):769-73.
PMID: 20604876