Weird Skin Stuff

July 2009

FocusWeird Skin Stuff

Blistering skin conditions

Volume 38, No.7, July 2009 Pages 484-490

Belinda Welsh


Blistering of the skin can be due to a number of diverse aetiologies. Pattern and distribution of blisters can be helpful in diagnosis but usually biopsy is required for histopathology and immunofluoresence to make an accurate diagnosis.


This article outlines the clinical and pathological features of blistering skin conditions with a particular focus on bullous impetigo, dermatitis herpetiformis, bullous pemphigoid and porphyria cutanea tarda.


Infections, contact reactions and drug eruptions should always be considered. Occasionally blistering may represent a cutaneous manifestation of a metabolic disease such as porphyria. Although rare, it is important to be aware of the autoimmune group of blistering diseases, as if unrecognised and untreated, they can lead to significant morbidity and mortality. Early referral to a dermatologist is important as management of blistering skin conditions can be challenging.

Blistering of the skin is a reaction pattern to a diverse group of aetiologic triggers and can be classified as either:

  • immunobullous (Table 1), or
  • nonimmunobullous (Table 2).

Separation of the skin layers leading to acquired blistering can occur due to loss of cohesion of cells:

  • within the epidermis (Figure 1)
  • between the epidermis and dermis (basement membrane zone) (Figure 2), or
  • in the uppermost layers of the dermis.

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