Dermatology – Blistering Eruptions: By Geeta Yadav M.D.


Blistering diseases of the skin range from
the autoimmune to the inflammatory. Here are a few conditions you want to be able
to recognize. The first is Allergic Contact Dermatitis,
a cell-mediated delayed (type IV) hypersensitivity reaction. This often presents as a dermatitic eruption
but certain allergens more often cause blistering – poison ivy, for example. ACD can also be caused by other allergens,
plant based or otherwise. These patient’s present with tense, localized,
pruritic blisters – usually on the extremities and sometimes in a linear pattern. These can occur in as little as 30 minutes
after exposure. Treatment includes oral steroids and topical
corticosteroids for the affected areas. The second are autoimmune blistering conditions. Bullous Pemphigoid (BP) is seen in elderly
patients and presents as a more generalized eruption of tense and very pruritic bullae
on a background of urticarial or normal skin. The bullae can be hemorrhagic and some might
be crusted. Pemphigus vulgaris (PV) presents as a generalized
eruption of flaccid blisters. The age of this patient population varies
and lesions in PV more commonly affect the mucous membranes (though this can be seen
in both conditions). Patients with BP or PV can have many comorbidities
and may require immunosuppressive therapy for treatment. Urgent referral to a dermatologist is recommended. Finally Erythema Multiforme (EM) and Stevens
Johnson Syndrome (SJS) are two conditions that can present as a bullous eruption often
on a background of erythematous skin. The palms and soles may be involved. Both conditions can have significant mucosal
erosions and the skin be pruritic or painful. In EM, the background erythema is target-like
and the underlying cause is often a viral infection, in most cases HSV. In SJS, the background erythema can become
dusky and rapidly coalesce. SJS is very serious and patients are typically
treated in intensive care or burn units. Medications are often the cause of SJS. A few that are more commonly implicated include
anticonvulsants, allopurinol, antibiotics, and non-steroidal anti-inflammatory drugs.

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