Diagnosis: Blisters
A medic cuts loose skin off a blister on the foot of an Army Reserve Best Warrior candidate at the conclusion of the 10km road march at the 2010 Army Reserve Best Warrior Competition at Fort McCoy, Wi. Clinical photograph sourced from Wikimedia Commons (Public domain). Attribution: Timothy Hale.
Tense bullae suggest subepidermal cleavage (bullous pemphigoid), while flaccid bullae with positive Nikolsky sign suggest intraepidermal cleavage (pemphigus). Distribution, mucosal involvement, and associated symptoms help narrow the differential.
Important to assess onset, distribution pattern, mucosal involvement, medication history, family history of blistering disorders, and associated symptoms. Recent infections, trauma, or sun exposure may be relevant.
Depends on etiology. Autoimmune: systemic corticosteroids, steroid-sparing agents (mycophenolate, rituximab). Infectious: appropriate antimicrobials. Supportive: wound care, pain management, nutritional support.
Pemphigus vulgaris, Bullous pemphigoid, Dermatitis herpetiformis, Linear IgA disease, Epidermolysis bullosa, Bullous impetigo
Direct immunofluorescence of perilesional skin is essential for diagnosing autoimmune blistering diseases. Nikolsky sign helps differentiate intraepidermal from subepidermal blistering.
Tags: blistering, vesiculobullous, autoimmune, bullae