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2nd installment of #dermtwitter #DistanceMedEd. Today's #tweetorial will be a brief one on...
VESICOBULLOUS REACTION PATTERN!
#MedEd #FOAMEd #dermatology #medtwitter
PC: @dermnetnz
2nd installment of #dermtwitter #DistanceMedEd. Today's #tweetorial will be a brief one on...
VESICOBULLOUS REACTION PATTERN!
#MedEd #FOAMEd #dermatology #medtwitter
PC: @dermnetnz
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First things first - some definitions:
Vesicle: fluid filled <1 cm
Bulla: fluid filled >1 cm
Pustule - Filled with pus
- Ahem, the word you're looking for describe something with a lot of pus is "purulent," not what you're thinking....🤨
First things first - some definitions:
Vesicle: fluid filled <1 cm
Bulla: fluid filled >1 cm
Pustule - Filled with pus
- Ahem, the word you're looking for describe something with a lot of pus is "purulent," not what you're thinking....🤨
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Next, the name is self explanatory. The vesicobullous pattern implies you're seeing vesicles or bullae. There is one very important exception:
If you see COLLARETTES of scale (round pattern of scale remnant), these can indicate a prior vesicle or bulla (like an old footprint)
Next, the name is self explanatory. The vesicobullous pattern implies you're seeing vesicles or bullae. There is one very important exception:
If you see COLLARETTES of scale (round pattern of scale remnant), these can indicate a prior vesicle or bulla (like an old footprint)
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The knee-jerk response when you hear vesicobullous I think is to think it's a blistering disorder right away. FWIW, here's my old #tweetorial on that group of diseases on a high level:
The knee-jerk response when you hear vesicobullous I think is to think it's a blistering disorder right away. FWIW, here's my old #tweetorial on that group of diseases on a high level:
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But, just because something is vesicobullous, it doesn't mean there's some autoimmunity going on. Things can be infectious (like bullous impetigo seen above), or it can be inflammatory (like pustular psoriasis).
What other reaction pattern often overlaps with vesicobullous?
But, just because something is vesicobullous, it doesn't mean there's some autoimmunity going on. Things can be infectious (like bullous impetigo seen above), or it can be inflammatory (like pustular psoriasis).
What other reaction pattern often overlaps with vesicobullous?
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Yes! Eczematous dermatitis can also be vesicobullous when acute. So think contact dermatitis - when someone gets an acute poison ivy dermatitis, it's also blistering.
Here's a part of my #tweetorial on "eczema" as a group of diseases if it helps!
Yes! Eczematous dermatitis can also be vesicobullous when acute. So think contact dermatitis - when someone gets an acute poison ivy dermatitis, it's also blistering.
Here's a part of my #tweetorial on "eczema" as a group of diseases if it helps!
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Some photos of examples of the different categories:
Pustular eruption - Pustular psoriasis (pic1)
Vesicular eruption - HSV (pic2)
Bullous eruption - Bullous pemphigoid (pic3)
Remember that in darker skin, things look different (pic4)! It's harder to see the erythema!
Some photos of examples of the different categories:
Pustular eruption - Pustular psoriasis (pic1)
Vesicular eruption - HSV (pic2)
Bullous eruption - Bullous pemphigoid (pic3)
Remember that in darker skin, things look different (pic4)! It's harder to see the erythema!
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Note:
Any vesicle or bulla can become purulent over time.
All tense bulla will become flaccid over time.
Everything can be "The Herp" (HSV) especially in inpatients (here's looking at you @MishaRosenbach).
Helpful question: Is it follicular?
These are helpful, but,👇
Note:
Any vesicle or bulla can become purulent over time.
All tense bulla will become flaccid over time.
Everything can be "The Herp" (HSV) especially in inpatients (here's looking at you @MishaRosenbach).
Helpful question: Is it follicular?
These are helpful, but,👇
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I put together a little Ddx chart. I literally came up with this right now, so I apologize ahead of time as this isn't exhaustive, but just as an example of what we think of when we are presented with an eruption.
Ultimately, it's like ACLS ;) --> Seek expert consultation!
I put together a little Ddx chart. I literally came up with this right now, so I apologize ahead of time as this isn't exhaustive, but just as an example of what we think of when we are presented with an eruption.
Ultimately, it's like ACLS ;) --> Seek expert consultation!
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Hope this helps a little. Ultimately, it's about looking at the overall picture and putting it together with other possible overlap reaction patterns to help you whittle down your ddx.
Thanks for joining! Leave any suggestions/requests! Stay safe out there with #COVID19!
Hope this helps a little. Ultimately, it's about looking at the overall picture and putting it together with other possible overlap reaction patterns to help you whittle down your ddx.
Thanks for joining! Leave any suggestions/requests! Stay safe out there with #COVID19!
