Blisters — Clinical Case (Wikimedia Commons)

Diagnosis: Blisters

Image shows how to treat an open blister successfully.. Clinical photograph sourced from Wikimedia Commons (CC BY-SA 4.0). Attribution: Samiland.

Clinical Presentation

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.

Clinical History

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.

Treatment

Depends on etiology. Autoimmune: systemic corticosteroids, steroid-sparing agents (mycophenolate, rituximab). Infectious: appropriate antimicrobials. Supportive: wound care, pain management, nutritional support.

Differential Diagnosis

Pemphigus vulgaris, Bullous pemphigoid, Dermatitis herpetiformis, Linear IgA disease, Epidermolysis bullosa, Bullous impetigo

Key Learnings

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