Etiology

Localized Distribution

Dependent Region Distribution

• Bullosis Diabeticorum (Bullous Disease of Diabetes) (see Diabetes Mellitus)
• Bullous Leukocytoclastic Vasculitis (see Vasculitis)
  • Physiology: deeper dermal small vessel vasculitis typically results in vesicular-bullous or palpable purpuric skin lesions
• Coma Bullae (see Coma Bullae)
• Edema (Stasis) Blisters

Dermatomal Distribution

• Herpes Zoster (see Varicella-Zoster Virus)

Hand/Feet Distribution

• Acute Palmoplantar (Dyshidrotic) Eczema
• Blistering Distal Dactylitis
  • Etiology
    • Staphylococcus Aureus (see Staphylococcus Aureus)
    • Streptoccous Pyogenes (see Streptococcus Pyogenes)
• Dermatophytosis
• Epidermolysis Bullosa Simplex
• Erythema Multiforme (EM) (see Erythema Multiforme)
• Friction Blisters
• Sucking Blisters

Linear Distribution

• Contact Dermatitis
  • Contact Dermatitis-Allergic (see Contact Dermatitis-Allergic)
  • Contact Dermatitis-Irritant (see Contact Dermatitis-Irritant)
• Phytophotodermatitis

Photodistribution

• Phototoxic Reaction
• Porphyria Cutanea Tarda (see Porphyria Cutanea Tarda)
• Polymorphous Light Eruption
• Pseudoporphyria
  • Epidemiology: associated with NSAID’s, tetracyclines, furosemide
• Sunburn

Other Distributions

• Bleomycin (Blenoxane) (see Bleomycin)
  • Clinical: xxx
• Bullous Dermatosis of Hemodialysis
• Bullous Impetigo (see Impetigo)
• Cellulitis (see Cellulitis)
• Cold Sore
• Clostridial Myonecrosis (Gas Gangrene): Clostridium species (see Clostridial Myonecrosis)
• Cutaneous Anthrax (see Bacillus Anthracis)
  • Clinical
    • Pruritic Vesicles/Papules: ulcerate and form eschars
    • Regional Lymphadenopathy (see Lymphadenopathy)
• Cutaneous Emboli (see Endocarditis)
  • Clinical: xxx
• Ecthyma Gangrenosum (see Ecthyma Gangrenosum)
• Ehrlichiosis (see Ehrlichiosis)
  • Microbiology: associated with Ehrlichia Canis
  • Clinical: may produce vesicles, bullous lesions, or pustules
• Erysipelas (see Erysipelas)
• Extramedullary Hematopoiesis (see Extramedullary Hematopoiesis)
  • Epidemiology: skin involvement is rare in extramedullary hematopoiesis
• Hand, Foot, and Mouth Disease (see Hand, Foot, and Mouth Disease)
  • Coxsackie A Virus (see Coxsackie Virus): Coxsackie is an Enterovirus family member
  • Enterovirus 71 (EV-71) (see Enterovirus 71): Enterovirus 71 is an Enterovirus family member
• Herpes Simplex Virus (HSV) (Herpes Gladiatorum, Herpetic Whitlow) (see Herpes Simplex Virus): intraepidermal
• Listeriosis (see Listeriosis)
  • Clinical: may produce vesicles, bullous lesions, or pustules
• Molluscum Contagiosum (see Molluscum Contagiosum)
  • Epidemiology: when occurs in genital region, it is considered a sexually-transmitted disease
    • Incubation: usually 2-6 wks
  • Organism: molluscum contagiosum is a poxvirus acquired by skin contact, fomites, or swimming pools
• Mycoplasma Pneumoniae (see Mycoplasma Pneumoniae)
  • Clinical: may produce vesicles, bullous lesions, or pustules
• Necrotizing Fasciitis (see Necrotizing Soft Tissue Infection)
• Neisseria Gonorrhoeae (see Neisseria Gonorrhoeae)
  • Clinical: may produce vesicles, bullous lesions, or pustules
• Neisseria Meningitidis (see Neisseria Meningitidis)
  • Clinical: may produce vesicles, bullous lesions, or pustules
• Orf (see Orf, [[Orf]])
  • Epidemiology: incubation period of 3-7 days
  • Organism: orf virus is a parapoxvirus acquired via puncture wounds from sheep/goats
  • Clinical: erthematous or purulent-appearing maculopapular lesion without systemic symptoms
• Phlegmasia Cerulea Dolens (see Deep Venous Thrombosis)
  • Epidemiology: xxx
  • Clinical: xxx
• Pseudomonas Aeruginosa (see Pseudomonas Aeruginosa)
  • Clinical: may produce vesicles, bullous lesions, or pustules
• Rickettsialpox (see Rickettsialpox)
  • Microbiology: Rickettsia Akari
  • Clinical: may produce vesicles, bullous lesions, or pustules
• Rocky Mountain Spotted Fever (see Rocky Mountain Spotted Fever)
  • Microbiology: Rickettsia Rickettsii
  • Clinical: may produce vesicles, bullous lesions, or pustules
• Scedosporiosis (Disseminated) (see Scedosporiosis)
  • Clinical: erythematous-purple papules or nodules or bullae
• Scorpion Sting (see Scorpion Sting)
  • Epidemiology: local bullae may form at the sting site from Hemiscorpius Lepturus (Liochlidae Family) scorpion envenomations
• Secondary Syphilis (see Syphilis)
• Smallpox (see Smallpox)
  • Organism: variola virus
• Staphylococcal Toxic Shock Syndrome (TSS) (see Staphylococcus Aureus)
• Tularemia (see Tularemia)
• Vibrio Vulnificus (see Vibrio Vulnificus)
  • Clinical: xxx

Generalized Distribution

Flaccid Bullous Lesions or Skin Sloughing

• Paraneoplastic Pemphigus
• Pemphigus Foliaceus
• Pemphigus Vulgaris (see Pemphigus Vulgaris)
• Staphylococcal Scalded Skin Syndrome (see Staphylococcal Scalded Skin Syndrome, [[Staphylococcal Scalded Skin Syndrome]])
• Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) (see Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis)
  • Epidemiology: most commonly associated with antibiotics, anticonvulsants, allopurinol, dapsone, and NSAID’s

Tense Bullous Lesions

• Bullous Pemphigoid (see Bullous Pemphigoid)
• Bullous Systemic Lupus Erythematosus (see Systemic Lupus Erythematosus)
• Dermatitis Herpetiformis (see Dermatitis Herpetiformis)
  • Epidemiology: associated with gluten enteropathy
• Epidermolysis Bullosa Acquisita
  • Epidemiology: associated with inflammatory bowel disease
• Fixed Drug Eruption
  • Associated Medications
    • Nonsteroidal Anti-Inflammatory Drug (NSAID) (see Nonsteroidal Anti-Inflammatory Drugs, [[Nonsteroidal Anti-Inflammatory Drug]])
    • Sulfonamides (see Sulfonamides)
    • Tetracyclines (see Tetracyclines)
• Linear IgA Bullous Dermatosis
  • Associated Medications
    • Angiotensin Converting Enzyme (ACE) Inhibitors (see Angiotensin Converting Enzyme Inhibitors, [[Angiotensin Converting Enzyme Inhibitors]])
    • Cephalosporins (see Cephalosporins)
    • Nonsteroidal Anti-Inflammatory Drug (NSAID) (see Nonsteroidal Anti-Inflammatory Drugs)
    • Penicillins (see Penicillins)
    • Vancomycin (see Vancomycin)
• Mucous Membrane Pemphigoid
• Paraneoplastic Pemphigus
• Pemphigoid Gestationis

Predominantly Vesicular Lesions

• Dermatitis Herpetiformis (see Dermatitis Herpetiformis)
  • Epidemiology: associated with gluten enteropathy
• Disseminated Herpes Simplex Virus (HSV) (see Herpes Simplex Virus)
• Varicella-Zoster Virus (VZV) (see Varicella-Zoster Virus)
  • Clinical
    • Prodrome (Anorexia/Fatigue/Malaise/Pharyngitis) Followed (in Approximately 24 hrs) by the Development of Macular Rash, Rapidly Progressing to Papular Rash, Then Subsequently to Pruritic Vesicular Rash
• Fixed Drug Eruption
  • Associated Medications
    • Nonsteroidal Anti-Inflammatory Drug (NSAID) (see Nonsteroidal Anti-Inflammatory Drugs)
    • Sulfonamides (see Sulfonamides)
    • Tetracyclines (see Tetracyclines)
• Milaria Crystallina
• Pemphigus Foliaceus
• Sweet’s Syndrome (Acute Febrile Neutrophilic Dermatosis) (see Sweet’s Syndrome)

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Physiology

Histopathologic Site of Blister Formation

Intracorneal/Subcorneal

• Bullous Impetigo (see xxxx, [[xxxx]])
• Milaria Crystallina
• Pemphigus Foliaceus
• Staphylococcal Scalded Skin Syndrome (see Staphylococcal Scalded Skin Syndrome)

Intraepidermal

• Acute palmoplantar (dyshidrotic) eczema
• Arthropod Bite: may be either intraepidermal or subepidermal
• Autoeczematization (id) reaction
• Contact Dermatitis (see xxxx)
• Epidermolysis bullosa simplex
• Friction blister
• Herpes simplex virus infection
• Polymorphous light eruption
• Varicella-Zoster Virus (VZV) (see Varicella-Zoster Virus)

Suprabasilar

• Paraneoplastic pemphigus: may be either suprabasilar or subepidermal
• Pemphigus vulgaris
• Transient acantholytic dermatosis
• Hailey-Hailey disease
• Darier’s disease

Subepidmermal

• Arthropod Bite: may be either intraepidermal or subepidermal
• Bullosis Diabeticorum (Bullous Disease of Diabetes) (see Diabetes Mellitus)
• Bullous leukocytoclastic vasculitis
• Bullous Pemphigoid (see xxxx)
• Bullous Systemic Lupus Erythematosus (see xxxx)
• Bullous Pyoderma Gangrenosum (see Pyoderma Gangrenosum)
• Coma Bullae (see Coma Bullae)
• Dermatitis herpetiformis (see xxxx)
• Dystrophic epidermolysis bullosa
• Epidermolysis bullosa acquisita
• Erythema Multiforme (see xxxx)
• Fixed drug eruption
• Linear IgA bullous dermatosis
• Junctional epidermolysis bullosa
• Mucous membrane Pemphigoid
• Paraneoplastic pemphigus: may be either suprabasilar or subepidermal
• Pemphigus Gestationis
• Phototoxic reaction
• Porphyria cutanea tarda
• Stevens-Johnson Syndrome (see xxxx)
• Sweet’s Syndrome

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Clinical

Definitions of Cutaneous Blisters

• Vesicle: <1 cm in size
  • Contain Serous, Serosanguinous, or Seropurulent Fluid
  • Discrete
    • May Be Grouped: as in Herpetic infection
    • May Be Irregularly Distributed
    • May Be Linear: as in Rhus dermatitis
  • Short-Lived: may break spontaneously or evolve into bullae (via enlargement or coalescence)
• Bullae: >1 cm in size
  • Contain Serous or Seropurulent Fluid
• Pustule: defined a vesicle which contains purulent exudate
  • Contain Purulent Fluid

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References

• xxxx