Vesiculobullous rashes

Background

  • 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
MaculeNoNoneflat, cirumscribed, colored
PapuleYesNoneSolid
VesicleYesClear
PustuleYesPusLeukocytes or keratin

Large lesions (>0.5cm)

Name Raised/Palpable Fluid-Filled Other Description Diagram
PatchNoNoneLarge macule (flat, colored)
PlaqueYesNoneSuperficially raised, circumscribed solid area
NoduleYesNoneDistinct large papule
BullaYesClearLarge vesicle/blister or exposed epidermal layer
WhealYesEdemaFirm and edema of dermis

Other

  • Plaque/scaley papule
  • Eschar
  • Fissure/erosion/ulcer
  • Purpura/petechia
  • Plaque/smooth papule

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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