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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.

Description
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● 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

Drawings
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Layers of skin

   
Epidermal basement membrane

Intraepidermal bullae
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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
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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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