Blistering


Blistering = Please note the three "D"s - Development, Duration, Distribution (± itch)

Localised
Eczema

Pompholyx blisters on hands & feet, itching

Allergic Rxn

Include insect bites & topical applications

Psoriasis

Deep sterile non-itching blisters on soles & palms

Impetigo

Usually localised, Staph & Strep isolated

Herpes simplex

Itching lesions develop turbid blisters

Generalised
Eczema

Lichenification, crusting itching

Dermatitis herpetiformis

Itching, extensor surfaces, persisting, superficial blisters
Coeliac disease.
Linear deposits of IgA along basement membrane.
Px - Dapsone, sulphapyridine, no gluten.

Chickenpox

Prodromal illness. Crops blisters, self limiting. May affect mucous membranes

Pityriasis lichenoides

Very to chickenpox but no infective agent. May last for months

Erythema multiforme

Deep blisters in target lesions. Mucous membranes. Drugs/bugs

Pemphigoid

Older patients. Trunk & flexures.
Preceding erythema then deep tense blisters.
Ab in dermo-epidermal junction. May cause scarring.
Remits after months of PO steroids.

Pemphigus

Adults. Widespread superficial blisters. Mucous membrane erosions.
Chronic. Nikolsky’s sign.
High morbidity despite steroids & azathioprine.