How do you approach a patient who presents with an acute onset of a vesiculobullous eruption?

The patient history is very important in the initial evaluation of blisters. If the onset of lesions was acute, exposure to contact allergens, arthropods, phototoxic and other drugs or chemicals, trauma, and infectious agents should be queried. Certain chronic vesiculobullous diseases may have an acute onset but may then persist or recur and become chronic (Table 10-2).

 

Table 10-2. Acute versus Chronic Onset of Vesiculobullous Eruption
	ACUTE		CHRONIC
	Allergic contact dermatitis Arthropod bites Drug eruptions (may become chronic if drug is not withdrawn) Erythema multiforme (may recur, especially with herpes simplex) Hand, foot, and mouth disease Herpes simplex Varicella zoster virus infections Impetigo Miliaria crystallina Physical, thermal, or chemical-induced blisters Toxic epidermal necrolysis/Stevens-Johnson syndrome		Bullous pemphigoid Bullous SLE Cicatricial pemphigoid Dermatitis herpetiformis Epidermolysis bullosa acquisita Linear IgA bullous dermatosis Pemphigus foliaceus Pemphigus vulgaris Genetic blistering diseases