Skin-nontumor / Clinical dermatology
Blistering disorders

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 8 June 2016, last major update July 2011

Copyright: (c) 2002-2016,, Inc.

PubMed Search: Blistering disorders [title]

Definition / General
  • Heterogeneous group of disorders affecting the skin or mucous membranes
  • Blister is a fluid filled cavity within or beneath the epidermis
  • Vesicles are 0.5 cm or less; bullae are greater than 0.5 cm
  • Diagnosis requires clinical information
  • Key histologic features for diagnosis are level of plane of separation, presence or absence of acantholysis, characterization of inflammatory infiltrate and immunofluorescent pattern
  • Large intraepidermal bullae without acantholysis may represent healed subepidermal bullae
  • Blisters can also be secondary to herpes infection, spongiotic dermatitis, burns, lupus erythematosus, lichen planus, scleroderma

Intraepidermal bullae
  • Suprabasal:
    • Pemphigus vulgaris and variants, paraneoplastic pemphigus, Darier’s disease

  • Spinous:
    • Spongiotic dermatitis, friction blister, miliara rubra, incontinentia pigmenti, IgA pemphigus, epidermolytic hyperkeratosis, Hailey-Hailey disease

  • Subcorneal:
    • Staphylococcal scalded skin syndrome, pemphigus foliaceus and variants, bullous impetigo, IgA pemphigus, subcorneal pustular dermatosis, erythema toxicum neonatorum, transient neonatal pustular melanosis, acropustulosis of infancy, miliaria crystallina

Subepidermal bullae
  • Damage to basal keratinocytes:
    • Epidermolysis bullosa simplex, thermal injury, erythema multiforme, herpes gestationis

  • Destruction or damage to epidermal basement membrane:
    • Lamina lucida layer: bullous pemphigoid, cicatricial pemphigoid, dermatitis herpetiformis, linear IgA dermatosis, porphyria cutanea tarda, epidermolysis bullosa acquisita, epidermolysis bullosa letalis (junctional), herpes gestationis, suction blister, thermal injury
    • Sublamina densa layer: cicatricial pemphigoid, linear IgA dermatosis, epidermolysis bullosa dystrophica, epidermolysis bullosa acquisita, bullous systemic lupus erythematosus
    • Dermal layer: penicillamine-induced blisters
Diagrams / Tables

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Layers of skin

Epidermal basement membrane