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Damage to this areas causes blisters The main immunobullous conditions are the pemphigus and pemphigoid disorders Epidermolysis bullosa (EB) comprises a group of genetically determined skin fragility disorders characterised by blistering of the skin and mucosae following mild mechanical trauma History Given the many causes of vesicles and bullae it is important to ascertain a thorough history , which includes: Speed of onset Was there any preceding itch / rash - this occurs in a number of conditions, especially bullous pemphigoid Are the lesions itchy eg pompholyx, or painful eg cellulitis, or Stevens-Johnson syndrome / toxic epidermal necrolysis Have any medications (prescribed or over the counter) been started recently Pets, such as dogs and cats, if infested by fleas or mites can cause a papular urticaria with bullae Recent travel - bed bugs can cause a papular urticaria Is anyone else affected eg bullous impetigo, papular urticaria Does the condition run in the family eg epidermolysis bullosa Is there anything unusual about the history or clinical appearance eg burns / scalds resulting from child abuse, self-harm or domestic violence Clinical findings This section is divided in to three parts: Red flags Common causes of vesicles and bullae Physical and chemical - friction blisters / UV-related: sunburn, polymorphic light eruption (prickly heat) / chilblains / bites & stings / burns & scalds / miliaria crystallina Leg oedema Infection - bacteria l (bullous impetigo, cellulitis) / viral (herpes zoster, herpes simplex, hand foot and mouth disease, orf) / others - scabies and tinea Eczema - pompholyx type eczema / contact allergic dermatitis Papular urticaria Uncommon / rare causes of vesicles and bullae - based on site Trunk / wider distribution - epidermolysis bullosa / epidermolytic hyperkeratosis (syn
