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
Macule No None flat, cirumscribed, colored Macule.png
Papule Yes None Solid Papule.png
Vesicle Yes Clear Vesicles (2).png
Pustule Yes Pus Leukocytes or keratin Pustules.png

Large lesions (>0.5cm)

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

Other

Ulcer, fissue, and erosion
  • 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.