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Skin-nontumor / Clinical Dermatology

Blistering disorders

Blistering disorders-general

Reviewer: Mowafak Hamodat, MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns, Canada (see Reviewers page)
Revised: 12 July 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.


● 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


Layers of skin

Epidermal basement membrane

Intraepidermal bullae

● Pemphigus vulgaris and variants, paraneoplastic pemphigus, Darierís disease

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

● 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

End of Skin-nontumor / Clinical Dermatology > Blistering disorders > Blistering disorders-general

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