Flexures Blisters

Blisters in the flexures

Blisters in the flexures usually mean a bullous staph infection or early bullous pemphigoid or linear IgA disease.It is possible a severe contact dermatitis to a topically applied cream could cause blisters but it would be  an uncommon presentation.Pemphigus vegetans gives very flacid bulla which rupture easily leaving only erosions with surrounding vegetative plaques..Hailey Hailey disease involves the flexures but again the blisters are so fragile they slough off leaving erosions and fissures in the skin.Secondary infection of these erosions by staph and candida is commonly seen.

Management  Culture and biopsy with immunofluorescence once you have taken a good history.

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,Burns, Insect bite reaction,Lymphedema,Puva blisters,Tanning bed Pseudoporphyria,Polymorphous light eruption,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,Bullous ichthyosiform erythroderma

Hemorrhagic Blisters  pemphigus,herpes zoster,leukemia,lichen sclerosus