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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