Blistering skin diseases

Last updated: July 27, 2022

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This article provides an overview of blistering skin diseases, including bullous impetigo, staphylococcal scalded skin syndrome (SSSS), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), epidermolysis bullosa acquisita, bullous pemphigoid, pemphigus vulgaris, and dermatitis herpetiformis.

For more information on each specific condition, see the respective articles.

Overview of blistering diseases
Median age Etiology Clinical features Treatment
Bullous impetigo
  • 2–6 years of age
  • Vesicles that grow to form large, flaccid bullae, which go on to rupture and form thin, brown crusts
  • Affects the trunk and upper extremities
  • Severe cases: systemic signs (e.g., fever, malaise, weakness)
  • Negative Nikolsky sign
Staphylococcal scalded skin syndrome (SSSS)
  • 6 months–5 years of age
Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN)
  • All ages
  • Discontinue causative drug
  • Supportive therapy and wound management
  • Antibiotic therapy (in infection/sepsis)
  • Regular dermatological, ophthalmological, and urological/gynecological evaluation
Epidermolysis bullosa acquisita
  • 40–60 years of age
  • Subepidermal blistering
  • Noninflammatory form (most common)
    • Tense vesicles and blisters on extensor surfaces (e.g., hands, knees, knuckles)
  • Inflammatory form
    • Tense vesicles and bullae on areas such as the trunk and skin folds)
  • Negative Nikolsky sign
Bullous pemphigoid
  • > 60 years of age
Pemphigus vulgaris
  • 40–60 years of age
  • Initially affects the oral mucosa before extending to parts of the body exposed to pressure
  • Progression in stages
  • Pruritus is typically absent
  • Positive Nikolsky sign
Dermatitis herpetiformis
  • 15–40 years of age
  • Most likely genetic predisposition to autoimmune reaction
  • Associated with celiac disease and sensitivity to potassium iodide (e.g., contrast medium)

Nikolsky sign is positive in intraepidermal blisters and is therefore present in pemphigus vulgaris and severe exfoliative skin conditions (SSSS, SJS, TEN).

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