Treating The Acute Onset Of An Asymptomatic Solitary Blister

M. Joel Morse, DPM

   Irritant dermatitis. Chemical irritants that can cause the condition include: chlorine, cleansers, detergents and soaps, fabric softeners, glues on artificial nails, perfumes and topical medications. Skin lesions present with severe pruritus at the site of contact with an erythematous, edematous area. Vesicles and bullae may develop, and these are usually linear or grouped.

   Vesicular tinea pedis. This causes vesicles between the toes, on the sides and tops of the feet. These may become larger and form blisters. When the lesions burst, they leave scales. Vesicular tinea pedis is usually extremely itchy.

   Pompholyx (dyshidrotic eczema). This type of eczema of unknown cause is characterized by a pruritic vesicular eruption on the fingers, palms and soles. A more appropriate term for this vesicular eruption is pompholyx, which means bubble. The clinical course of dyshidrotic eczema can range from self-limited to chronic, severe or debilitating. Dyshidrotic eczema is considered to be a reaction pattern caused by various endogenous conditions and exogenous factors. The hypothesis of sweat gland dysfunction has been in dispute because researchers have not shown that vesicles are associated with sweat ducts. A 2010 case report provided clear histopathologic evidence that sweat glands do not play a role in dyshidrosis.6

   Blistering distal dactylitis. This is an acute superficial infection of the anterior fat pad of the digit caused by group A streptococci or Staph aureus. This occurs as a purulent vesicle or bulla on an erythematous base.7

   Bullous drug eruptions. Blisters occur as a complication of the administration of drugs, resulting in bullous drug eruptions. The more common drugs are sulfonamides, non-steroidal anti-inflammatory drugs and anti-seizure meds. This manifests with a very inflammatory base.

   Bullous pemphigoid. This is most common in subepidermal bullous disease. Bullous pemphigoid is a disease of elderly men. Urticarial lesions precede tense bullous lesions. It is caused by autoantibodies directed against proteins.

   Epidermolysis bullosa. This is a family of diseases that shows blistering in response to mild trauma. The condition occurs on both cutaneous surfaces and mucosal tissue. Different epidermolysis bullosa subtypes are based on the cleavage plane of the blister and caused by keratin gene mutations.

   Bullous impetigo. This affects infants and children younger than 2 years. It causes painless, fluid-filled blisters that are usually on the trunk, arms and legs. The skin around the blister is usually red and itchy, but not sore. The blisters break and scab over with a yellow-colored crust.

   Bullous erythema multiforme. Infections, most commonly the herpes simplex virus, usually trigger this hypersensitivity reaction. Bullous erythema multiforme presents with a skin eruption characterized by a typical target lesion. There may be mucous membrane involvement. It is acute and self-limiting, usually resolving without complications. The upper limbs are more commonly affected than the lower. Palms and soles may be involved. The face, neck and trunk are common sites. Skin lesions are often grouped on elbows and knees. There may be an associated mild itch or burning sensation.

How A Focus On Basic Dermatology Can Help Identify Bullous Diabeticorum

Vesicle and bulla. A vesicle is a fluid-filled cavity or elevation smaller than 0.5 cm and a bulla measures large than 0.5 cm.2 Other authors use the size 1.0 cm as the split between the vesicle and the bullae.5 Vesicles may be discrete, irregularly scattered or grouped as in herpes zoster or linear as in allergic contact dermatitis. Other examples include: poison ivy, early chicken pox, herpes simplex and dyshidrosis.

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