Arms and Legs Blisters

Blisters on the arms and legs 

The commonest cause is plant contact eczema where the smaller vesicles have joined up to form a blister.On the sun exposed areas of the arms and legs porphyria cutanea tarda may cause blisters and skin fragility and erosions.Because of trauma it is also a site for epidermolysis bullosa and acquisita.Phytophoto reactions from limes,parsley and celery can also cause blisters on the dorsum of the exposed areas.Erythema multiforme may also cause acral blisters and target lesions.On the lower legs blistering insect bite reactions are not uncommon.Localised bullous pemphigoid can also occur on the lower legs and diabetic blisters.

Management.  Always do a Tzanck smear to look for the multinucleate giant cells of herpes virus.Take a good history of plant exposure and test for porphyria.Do immunofluorescence if you suspect Epiermolysis bullosa aquisita or bullous pemphigoid.

SIGN DIP MEN  Overview of Blisters

 

S-Squamous    Bullous Dariers disease,

 

I-Infective   Impetigo,Staph scalded skin syndrome,Herpes zoster,Bullous tinea,Parvovirus B19,Staph infected varicella,Bullous orf,Pseudomonas septicemia,Hemorrhagic bullae with Vibrio vulnificus,Mucor infection in immunosupressed,Blistering dactylitis

 

G-Granulomatous

 

N-Neoplastic  Paraneoplastic pemphigus,

 

D-Drugs   Toxic epidermal necrolysis,Fixed drug eruption,Numerous drugs causing the immunobullous disaeases,Pseudoporphyria,Barbiturate coma,

 

I-Immunological    Plant contact dermatitis,Phytophoto dermatitis,Erythema multiforme,Bullous pemphigoid,Pemphigus,Dermatitis herpetiformis,Linear igA disease,Chronic bullous dermatosis of childhood,Bullous lupus, Mucosal Pemphigoid,Epidermolysis bullosa aquisita,Herpes Gestationis,Lichen sclerosus ,Bullous morphea,Bullous necrotising vasculitis,

 

P-Physical   Friction blister, Insect bite reaction,Lymphedema,Puva blisters,Tanning bed Pseudoporphyria,Edema blisters of the leg,Sucking blisters in neonates,Epidermolysis bullosa,

 

M-Metabolic    Porphyria cutanea tarda,Diabetes mellitus,Amyloidosis,Blisters of hemodialysis,Mastocytosis,

 

E-Endocrine   Hypothyroidism,

 

N-Nutritional    Pellagra,Acquired zinc deficiency,Acrodermatitis enteropathica,

 

Others   Pompholyx eczema palms and soles,Congenital syphilis,Kindler syndrome,Neonatal purpura fulminans,Incontinentia pigmenti,