Bullous disorders

1. subcorneal:

• impetigo (有bacterial clump), SSSS(inflammation 少), pustular fungal infection
• superficial pemphigus: pemphigus foliaceus, pemphigus erythematosus, pemphigus herpetiformis, IgA pemphigus (後兩者可intraepidermal)
• subcorneal pustular dermatosis (N多, pus 大片較集中)
• pustular psoriasis, Reiter's syndrome
• AGEP

     2. intraepidermal spongiotic: eczema

     3. intraepidermal ballooning: virus: VZV, HSV, hand-foot-mouth, orf, ~pox

     4. intraepidermal necrolysis: physical (friction blister), nutritional deficiency (zinc, niacin (vitamin B3) deficiency: pellagra, necrolytic migratory erythema (glucagonoma syndrome))

     5. suprabasal acantholysis:

         focal: Darier's disease, Grover;s disease

         generalized: pemphigus vulgaris, pemphigus vegetans

     6. annular blisters: if KOH (-): biopsy + DIF to rule out pemphigus herpetiformis, IgA pemphigus

     7. eroded desquamation: DIF to rule out pemphigus foliaceus, pemphigus erythematosus

     8. macerated plaques: DIF to rule out pemphigus vegetans, pemphigoid vegetans