Face Vesicles

 If there are Blisters or vesicles The mnemonic is ICI(Imperial Chemical Industries) Infective, Contact dermatitis and Inflammatory including Immunological .
Inflammatory causes can include drugs but remember Immunological causes in the elderly particularly bullous pemphigoid. Contact dermatitis usually gives smaller vesicles rather than blisters but individual vesicles can join up into blisters. If blisters are linear and itchy it is probably a Plant contact dermatitis. Infective blisters are usually bullous impetigo due to a staph infection. If in a dermatomal distribution blisters are likely to be Herpes Zoster.

Vesicles on the face can be classified into Grouped or Disseminated.Grouped vesicles are Herpes simplex,Herpes zoster,Chickenpox and Contact dermatitis.Disseminated vesicles include the first 3 in rare situations such as Kaposi's varicelliform eruption where the patient has underlying atopic dermatitis.Contact dermatitis could also be more diffuse if a cream was applied over the face or a hair dye spread on to the face.

Management - Swab for viral culture or PCR examination for herpes simplex or do a Tzank smear 

 

SIGN DIP MEN  Overview of Vesicles

 

S-Squamous    Eczema or Contact dermatitis,Vesicular Darier’s disease,Vesicular tinea,

 

I-Infective      Herpes simplex and Zoster,Chickenpox,Vesicular tinea pedis,Hand foot and mouth disease,Molluscum,Erysipelas,

 

G-Granulomatous

 

N-Neoplastic

 

D-Drugs   Fixed drug reaction

 

I-Immunological  Atopic eczema,nummular eczema and allergic contact eczema, All the immunobullous diseases have a milder vesicular stage but especially Dermatitis Herpetiformis,

 

P-Physical   Polymorphous light eruption,Hydroa vacciniforme,Scabies(children and immunosupressed),Miliaria,Caterpillar dermatitis,Insect bite reactions,

 

M-Metabolic   Porphyria cutanea tarda,

 

E-Endocrine

 

N-Nutritional