Dermatology Differential Diagnosis by Morphology

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Epidermal Vesicular / Bullous Lesions

1. Pemphigus vulgaris - Examples #1.
2. Pemphigus erythematosus (Senear-Usher Syndrome)
3. Pemphigus foliaceus - Examples #1, #2.
4. Pemphigus vegetans
5. Benign familial pemphigus (Hailey and Hailey Disease)
6. Incontinentia pigmenti - Examples #1, #2, #3, #4.
7. Toxic epidermal necrolysis
8. Impetigo / Bullous impetigo
9. Bullous congenital ichthyosiform erythroderma
10. Epidermolysis bullosa simplex
11. Cockayne's disease (Recurrent bullous eruption of hands and feet)
12. Cantheridine
13. Miliaria crystallina
14. Miliaria rubra
15. Acrodermatitis enteropathica
16. Eczematous blisters:
    • Allergic and contact dermatitis (e.g. garlic) - Examples: See Image Database
    • Fungal: Inflammatory infections and id reactions
    • Dyshidrosis (Pompholyx)
    • Ultraviolet light
    • Others
17. Bacterial vesicles / papulovesicles
    • Impetigo / Bullous impetigo
    • Gonococcemia - often hemorrhagic
18. Viral vesicles:
    • Hand, foot and mouth disease (Coxsackie A₁₆) - Examples: See Image Database
    • Varicella - Zoster - Examples: See Image Database
    • Herpes simplex - Examples: See Image Database
    • Variola
    • Others
19. Parasitic vesicles:
    • Scabies - Examples: See Image Database

Subepidermal Vesicular / Bullous Lesions

1. Erythema multiforme - Examples: #1, #2, #3.
2. Bullous Pemphigoid - Examples: #1, #2.
3. Cicatricial pemphigoid (Benign mucosal pemphigoid)
4. Dermatitis herpetiformis
5. Dermolytic epidermolysis bullosa:
   • Dominant
   • Recessive
   • Acquired - Examples: #1, #2.
6. Junctional epidermolysis bullosa
7. Mendes da Costa Syndrome (Macular dystrophic epidermolysis bullosa)
8. Porphyria cutanea tarda
9. Bullous lupus erythematosus
10. Bullous lichen planus
11. Fixed drug eruption (i.e. barbiturates)
12. Burns
13. Suction
14. Friction or shearing forces
15. Trauma (i.e. secondary to a bone fracture)
16. Lichen sclerosis et atrophicus
17. Urticaria pigmentosa
18. Vesicular polymorphous light eruption
19. Herpes gestationis
20. Ionizing radiation

Vesicular / Bullous Lesions of the Hands

1. Hand, foot and mouth disease (Coxsackie A₁₆) - Examples: See Image Database
2. Acute eczematous dermatitis
3. Dermatophytid
4. Dyshidrotic eczema
5. Scabies - Examples: See Image Database
6. Bullous erythema multiforme - Example: #1.
7. Epidermolysis bullosa syndromes - Examples: See Image Database
8. Congenital syphilis
9. Porphyria cutanea tarda
10. Erysipeloid
11. Physical factors
12. Viral: Herpes simplex, varicella - zoster, others. - Examples: See Image Database
13. Toxic epidermal necrolysis
14. Bullous lichen sclerosis et atrophicus
15. Fixed drug
16. Blister beetles

Grouped Vesicles and Pustules

1. Herpes simplex - Examples: See Image Database
2. Herpes zoster - Examples: See Image Database
3. Impetigo herpetiformis
4. Dermatitis herpetiformis
5. Herpes progenitalis
6. Herpes gestationis
7. Subcorneal pustulosis

Umbilicated Vesicles

1. Varicella - Examples: See Image Database
2. Vaccinia
3. Herpes simplex - Examples: See Image Database
4. Herpes zoster - Examples: See Image Database
5. Variola

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