Vesiculobullous Skin Rash - Differential Diagnosis Algorithm

Vesicles Fragile/EasiIy Ruptured - Intraepidermal blisters, possibly crusts/erosions

 - Inflammatory

     • Pemphigus vulgaris

     • Pemphigus foliaceus

 - Infectious

     • Varicella zoster (chickenpox)

     • Herpes zoster (shingles)

     • Herpes simplex

     • Bullous impetigo

 - Reaction to Agent

     • Contact dermatitis

Vesicles NOT Fragile/NOT Easily Ruptured - Subepidermal blisters, tense intact blisters

 - Inflammatory

     • Bullous pemphigoid

     • Mucous membrane pemphigoid

     • Dermatitis herpetiformis

     • Bullous systemic lupus erythematous

 - Metabolic

     • Porphyria cutanea tarda

     • Diabetic bullae (bullous diabeticorum)

 - Reaction to Agent

     • Phototoxic drug eruption



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