Vesiculobullous rashes

Background

Normal dermal anatomy.
  • Vesiculobullous disorders characterized by involvement of the dermal-epidermal junction (causing fluid-filled lesions to form)

Rash Red Flags[1]

Dermatology Nomenclature

Small lesions (<0.5cm)

Name Raised/Palpable Fluid-Filled Other Description Diagram
Macule No None flat, cirumscribed, colored
Papule Yes None Solid
Vesicle Yes Clear
Pustule Yes Pus Leukocytes or keratin

Large lesions (>0.5cm)

Name Raised/Palpable Fluid-Filled Other Description Diagram
Patch No None Large macule (flat, colored)
Plaque Yes None Superficially raised, circumscribed solid area
Nodule Yes None Distinct large papule
Bulla Yes Clear Large vesicle/blister or exposed epidermal layer
Wheal Yes Edema Firm and edema of dermis

Other

Ulcer, fissue, and erosion

Clinical Features

  • Vesicles are small (<1cm)
  • Bullae are larger (>1cm)

Vesiculobullous rashes visual diagnosis

Differential Diagnosis

Vesiculobullous rashes

Febrile

Afebrile

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

Management

  • Based on presumed cause

Disposition

  • Based on presumed cause

See Also

References

  1. ↑ Nguyen T and Freedman J. Dermatologic Emergencies: Diagnosing and Managing Life-Threatening Rashes. Emergency Medicine Practice. September 2002 volume 4 no 9.
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