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Vesiculobullous rashes
From WikEM
Contents
Background
- Vesiculobullous disorders characterized by involvement of the dermal-epidermal junction (causing fluid-filled lesions to form)
Rash Red Flags[1]
- Fever
- Toxic appearance
- Hypotension
- Mucosal lesions
- Severe pain
- Very old or young age
- Immunosuppressed
- New medication
Dermatology Nomenclature
Small lesions (<0.5cm)
- Macule – flat, cirumscribed, colored, non palpable
- Papule – raised, solid and palpable
- Vesicle – raised, palpable, clear fluid-filled
- Pustule – raised, palpable, pus filled (leukocytes or keratin)
Large lesions (>0.5cm)
- Patch – large macule (flat non-palpable colored area)
- Plaque – superficially raised, circumscribed solid area
- Nodule – distinct large papule
- Bulla - large vesicle (blisters if epidermal layer completely sloughed off)
- Wheal – firm and edematous plaque (edema of the dermis)
Other
- Plaque/scaley papule
- Eschar
- Erosion/ulcer
- Purpura/petechia
- Plaque/smooth papule
Clinical Features
- Vesicles are small (<1cm)
- Bullae are larger (>1cm)
Differential Diagnosis
Vesiculobullous rashes
Febrile
- Diffuse distribution
- Varicella
- Smallpox
- Disseminated gonococcal disease
- DIC
- Purpural fulminans
- Localized distribution
Afebrile
- Diffuse distribution
- Bullous pemphigoid
- Drug-Induced bullous disorders
- Pemphigus vulgaris
- Phytophotodermatitis
- Erythema multiforme major
- Localized distribution
Evaluation
- Frequently a clinical diagnosis based on ruling-out more dangerous causes
- See differential diagnosis section (above)
- Consider whether or not the patient has a fever or is toxic appearing (dangerous diagnosis)
- Look at lesion distribution
Vesiculobullous rashes visual diagnosis
Management
- Based on presumed cause
Disposition
- Based on presumed cause
See Also
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