Bullous dermatitis is an inflammatory lesion of the skin with the formation of fluid—filled bubbles on it. Most often, bullous dermatitis occurs as a result of skin contact with some aggressive environmental factor. However, it can be a symptom of other dermatological diseases, a consequence of metabolic and endocrine disorders, or a manifestation of genetic abnormalities. In the diagnosis of bullous dermatitis, it is of great importance to determine the external factor affecting the skin, to identify concomitant pathology, laboratory diagnostics and biopsy.
General information
In bullous dermatitis, the blisters are located under the epidermis (subepidermally) or directly in it (intraepidermally). Subepidermal localization of blisters is characteristic of bullous pemphigoid, bullous form of systemic lupus erythematosus, epidermolysis bullosa. Intraepidermal blisters appear in erythroderma bullosa, Hayley-Hayley disease. With a size of more than 5 mm, bubbles are called bulls, less than 5 mm — vesicles.
Causes
External factors causing contact bullous dermatitis include exposure to sunlight and artificial sources of ultraviolet radiation, low and high temperatures, aggressive chemicals (turpentine, ursol, hair dye, etc.), some plants and medicines. At the same time, bullous dermatitis can be caused by the direct influence of a factor (simple contact dermatitis) or an allergic reaction provoked by it (allergic contact dermatitis).
Disease can be a manifestation of infectious diseases: herpes, bullous dermatophytia, impetigo; inflammatory dermatoses: pemphigus erythematosus, bullous systemic lupus erythematosus, bullous pemphigoid; metabolic disorders: porphyria, pellagra, diabetic bullosis, enteropathic acrodermatitis; genetic abnormalities: congenital bullous erythroderma, Hayley-Hayley disease, epidermolysis bullosa.
Symptoms
Bullous dermatitis from exposure to low temperature is frostbite. They are characterized by initial vascular spasm. Then the vessels dilate and redness appears on the skin, accompanied by a burning sensation and pain. Puffiness joins and sluggish bubbles with serous or bloody contents appear. The erosions formed after the opening of the bubbles are covered with crusts during healing. Exposure to high temperature on the skin causes burns. Their clinical picture is similar to frostbite, but blisters form immediately after exposure. Bullous dermatitis occurs with frostbite or a burn of the II degree.
Solar bullous dermatitis develops within a few hours after being exposed to direct sunlight for too long. After reddening of the skin, bubbles of different sizes form on it. With solar dermatitis, itching, soreness and burning are noted, fever and general well-being may increase. After the erosions heal, areas of hyperpigmentation remain on the skin.
Bullous dermatitis from chemical factors, arising on a skin area that has been in contact with a chemical substance, can then take on a generalized character. So, when in contact with ursol, the favorite location of bubbles during generalization is the face and neck. The resulting swelling can capture the eyelids with the complete closure of the eye slit.
Metabolic bullous dermatitis develops against the background of existing endocrine diseases or metabolic disorders. Diabetic bullosis occurs in diabetes mellitus of any type. With it, tense blisters are located on the distal parts of the legs or arms. Enteropathic acrodermatitis is associated with a lack of zinc and is characterized by the localization of blisters on the distal extremities, in the mouth, on the lips and around the eyes.
Hereditary bullous dermatitis usually develops immediately after birth. Epidermolysis bullosa is characterized by spontaneous sudden appearance of blisters and their formation in places of minor injury to the skin. Hayley-Hayley disease has a clinical picture of pemphigus, but is transmitted by inheritance.
Diagnostics
First of all, the clinical picture of bullous dermatitis is evaluated. It matters the location of the bubbles, their nature, size, number and stages of development, symmetry of the lesion, involvement of the mucous membranes.
In the diagnosis of bullous dermatitis of a contact nature, much attention is paid to identifying the provoking factor. If the infectious nature of the bubbles is suspected, bacterioscopy is performed and the liquid contained in them is seeded.
One of the informative methods of diagnosis of bullous dermatitis is a biopsy followed by histological examination. As a biopsy material, a fresh intact bladder is taken, slightly capturing the skin located around it. To confirm the allergic nature of dermatitis, in addition to histological examination, direct and indirect immunofluorescence (RIF) reactions are carried out.
Diagnosis of hereditary bullous dermatitis is carried out using electron microscopic examination. If porphyria is suspected, urine is examined for the presence of porphyrins, if enteropathic acrodermatitis is suspected, the concentration of zinc in the blood is determined.
Treatment
In the treatment of contact bullous dermatitis, the main thing is the elimination of the provoking factor. If dermatitis is a manifestation or complication of other diseases, then first of all the treatment of the underlying disease is carried out. With hereditary forms of this disease, symptomatic treatment is carried out.
Locally, corticosteroid and antibacterial ointments, anti-inflammatory mixtures, means that promote the healing of erosions remaining after blisters can be used. If necessary, the bubbles are opened with careful observance of the conditions of sterility.
