bullous disease of skin

Vesicular and Bullous type skin diseases

Diagnosis

Erythema multiforme is not as a rule difficult to diagnose, but the vesicular and bullous type may have to be distinguished from pemphigoid. Erythema multiforme occurs in a much younger age group and is a more obviously centrifugal disease, affecting the hands and feet, elbows, knees and neck. Cases with small vesicles may cause confusion with dermatitis herpetiformis. In the latter disease the eruption tends to be less symmetrical, has less tendency to be limited to the extremities, irritates much more, and is often accompanied by an eosinophilia. Cases with the eruption chiefly on the face may be confused with lupus erythematosus . In this disease, however, the nose and ears are often affected and the follicles on the affected part are filled with little horny plugs which give the skin a stippled appearance. Lupus erythematosus usually follows a, very chronie course while erythema multiforme is essentially an acute disease.

Prognosis. The eruption will probably disappear in two to three weeks leaving no scars, but it is very liable to recur.

Treatment

Every effort should be made by means of a careful history and thorough general examination to find a cause and this should then be treated. Little else can be done and no drug has any specific effect in the condition. When the mucous membranes are involved, especially those in the eye, local or systemic antibiotics may be needed  to control secondary infection. Steroid hormones given systematically appear to be helpful in certain of the severe bullous and mucosal cases.