Vesicles and Bullae: Or something else? Differential Diagnosis

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Porphyria or acute intermittent porphyria (AIP); genetic disorder with autosomal dominant inheritance; patients with this disease have a 50% reduction in the activity of the enzyme porphobilinogen deaminase (PBG-D), which is sufficient for porphyrin synthesis. Triggers of a porphyria attack, which can last a few days but also months, are infections, drugs or alcohol. The clinical picture of these attacks presents as acute abdomen or neurological deficits, which can take a lethal course. The leading symptoms of acute porphyria are intermittent neurologic and psychiatric disturbances. Autonomic neuropathy is often in the foreground, causing abdominal colic (acute abdomen), nausea (nausea), vomiting or constipation (constipation), as well as tachycardia (heartbeat too fast: > 100 beats per minute) and labile hypertension (high blood pressure).

Skin and subcutaneous (L00-L99).

  • Acne excoriata – acne with scratching sequelae.
  • Dermatitis herpetiformis – chronic skin disease with grouped standing vesicles.
  • Epidermiolysis bullosa hereditaria – group of rare genetic disorders with both autosomal dominant and autosomal recessive inheritance, characterized by blistering after the slightest trauma; leads to more or less severe disabilities and may lead to premature death
  • Erythema exsudativum multiforme (synonyms: erythema multiforme, cocard erythema, disc rose) – acute inflammation occurring in the upper corium (dermis), leading to typical cocard-shaped lesions; a distinction is made between a minor and a major form
  • Eczema (e.g., dyshidrosis (synonyms: Dyshidrosis, dyshidrotic eczema, dyshidrosiform eczema or pompholyx; symptoms: small, almost always itchy vesicles (“blisters”) on the finger sides, palms and soles (podopompholyx).
  • Impetigo (pus / crust lichen).
  • Impetigo bullosa – form of pemphigoid that occurs in the newborn.
  • Linear IgA dermatosis – most common blistering autoimmune disease in childhood; clinical presentation: annular, rosette-shaped blisters, confluent; predilection site (body regions where the changes occur most frequently): anogenital region (body area located around the anus (anus) and genitals (genitals)), extremities and trunk region, and in rare cases oral erosions (superficial corneal defect affecting the epithelium) or Ulcers (ulcers); trigger factors are previous infections and the use of various drug groups (eg, antibiotics, anti-inflammatory drugs).
  • Lyell’s syndrome (synonyms: epidermolysis acuta toxica; “scalded skin syndrome”) – acute skin lesion presented by vesicular detachment of the epidermis of the skin.
  • Pemphigoid – refers to skin diseases in which the epithelial layer is detached from the connective tissue by blistering.
  • Pemphigoid gestationis (synonym: herpes gestationis) – skin disease associated with blistering, which occurs in pregnant women.
  • Pemphigus – refers to severe skin diseases associated with blistering.
  • Polymorphous light dermatosis – delayed light reaction of the skin, which is associated with different efflorescences (skin changes).

Infectious and parasitic diseases (A00-B99).

  • Actinomycosis (ray fungal disease) – chronic infectious disease caused by Actinomyces israelii.
  • Erysipelas – non-purulent skin infection caused predominantly by ß-hemolytic group A streptococci (Streptococcus pyogenes). Hospitalization is indicated for blistering (erysipelas vesiculosum et bullosum) and bullous-hemorrhagic (blistering-bleeding) erysipelas.
  • Hand-foot-mouth disease (HFMK; hand-foot-mouth exanthema) [most common cause: Coxsackie A16 viruses].
  • Herpes simplex
  • Herpes zoster (shingles)
  • Cutaneous leishmaniasis – infectious disease caused by protozoa of the species Leishmania.
  • Tuberculosis
  • Varicella (chickenpox)

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Ulcerative dental fistula

Musculoskeletal system and connective tissue (M00-M99)

  • Allergic vasculitis (vascular inflammation), unspecified.

Neoplasms – tumor diseases (C00-D48).

  • Basal cell carcinoma (BCC; basal cell carcinoma) – malignant skin tumor that does not metastasize (form daughter tumors).
  • Keratoacanthoma – benign epithelial proliferation with central horny plug.
  • Lentigo maligna – slow-growing pigmented spot that is considered precancerous (precancerous).
  • Malignant melanoma (black skin cancer).
  • Oral cavity carcinoma (cancer of the oral cavity)
  • Squamous cell carcinoma – malignant cancer of the skin / mucosa.

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Edema (water retention) in the legs, unspecified; this may be secondary to the formation of vesicles (“vesicles”)

Injuries, poisoning, and other sequelae of external causes (S00-T98).

  • Insect bites
  • Burns, unspecified
  • Skin friction injuries, unspecified

Medication

  • ACE inhibitors
  • Barbiturates
  • Cinnarizine
  • Penicillamine