Blistering Disorders

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Overview

Blisters are accumulations of fluid between two layers of the skin. A lesion smaller than 0.5 centimeters is called a vesicle; when greater than 0.5 centimeters it is called a bulla (plural: bullae).

Blisters are caused by friction, trauma, or internal conditions. Some autoimmune diseases produce blisters when antibodies (immune proteins) attack the cells of the skin. This causes a cleavage between two layers of cells in which fluid accumulates.

Diagnosis of a particular blistering disorder usually is done by biopsy, in which a skin sample is taken from a blister's edge for microscopic evaluation. Sometimes a test called immunofluorescence is performed to look for specific immune proteins that help distinguish one blistering disorder from another.

Some blistering diseases are inherited. These genetic disorders can be diagnosed during pregnancy by chorionic villus sampling.

Treatment for blistering disorders varies with cause and the severity of the disease. Locally administered creams are sometimes effective. In some cases systemic therapy is required.

FAQs

Q: I have been getting large blisters on my skin for several months. What tests should my doctor perform to help diagnose my condition?

A: Your doctor will evaluate your condition based on your medical history, symptoms, and the physical characteristics of the blisters. He or she may elect to do a skin biopsy to help diagnose your condition. At times, a specialized analysis of the skin sample is done to check for autoimmune disorders.

Q: What is the difference between pemphigus and pemphigoid?

A: Both are blistering disorders caused by autoimmune problems that result in an attack on the skin cells by the individual's own antibodies. The attack may occur at various layers of the skin. Pemphigus causes a cleavage within the epidermis (top layer of the skin), and the blisters are flaccid and break easily. Pemphigoid produces a split below the epidermis, causing deeper, tense blisters. Pemphigoid is seen most often in the elderly. Both are treated with similar medications. Severe cases may require different treatment. Either condition may remit after a period of time.

Q: My first child has epidermolysis bullosa (EB). What are the chances of future children being affected?

A: Epidermolysis bullosa is a group of inherited blistering disorders. There are more than a dozen subtypes, some of which occur as autosomal-dominant and some as autosomal-recessive inheritance types. In the former, one parent is affected and passes the gene to the child. There is a 50% chance of this occurring with each pregnancy. When a disease occurs in an autosomal-recessive pattern, the child receives one affected gene from each parent. The combination of the two genes causes the disease. In such cases, it is possible that neither parent may be affected. Each subsequent pregnancy carries a 25% chance of the child having EB. Diagnosis can be made early in the pregnancy by sampling a piece of the tissue surrounding the fetus (chorionic villus sampling).

Q: I have pemphigoid, but I don't want to take steroids. What are my alternatives?

A: Some people respond to a combination of an antibiotic, tetracycline, and a B vitamin, niacinamide (also called

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