Vesiculobullous rashes
(Redirected from Bulla)
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)
| Name | Raised/Palpable | Fluid-Filled | Other Description | Diagram |
| Macule | No | None | flat, cirumscribed, colored | 
|
| Papule | Yes | None | Solid | 
|
| Vesicle | Yes | Clear | .png)
| |
| 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
- Eschar
- Fissure/erosion/ulcer
- Necrotizing rashes
Clinical Features
- Vesicles are small (<1cm)
- Bullae are larger (>1cm)
Vesiculobullous rashes visual diagnosis
Bullous impetigo (after the bulla have broken)
Poison ivy/Oak/Sumac
Poison ivy/Oak/Sumac
Differential Diagnosis
Vesiculobullous rashes
Febrile
- Diffuse distribution
- Varicella (chickenpox)
- Smallpox
- Monkeypox
- Disseminated gonococcal disease
- DIC
- Purpural fulminans
- Localized distribution
Afebrile
- Diffuse distribution
- Bullous pemphigoid
- Drug-Induced bullous disorders
- Pemphigus vulgaris
- Phytophotodermatitis
- Erythema multiforme major
- Bullous impetigo
- Localized distribution
- Contact dermatitis
- Herpes zoster (shingles)
- Dyshidrotic eczema
- Burn
- Dermatitis herpetiformis
- Erythema multiforme minor
- Poison Oak, Ivy, Sumac dermatitis
- Bullosis diabeticorum
- Bullous impetigo
- Folliculitis
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
- ↑ Nguyen T and Freedman J. Dermatologic Emergencies: Diagnosing and Managing Life-Threatening Rashes. Emergency Medicine Practice. September 2002 volume 4 no 9.