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A wide variety of disorders may produce intraepidermal vesicles and pustules. Distinct diseases may have similar or even identical pathologic features. In addition, the histopathologic findings in each disease evolve over time. Thus the algorithmic approach to diagnosis in this group is, of necessity, complex but facilitates the diagnosis in this group of disorders (Figs. 7-1, 7-2, 7-3, Table 7-1), and especially when correlated to clinical and historical data often proves essential. The algorithm narrows the differential diagnosis to a few entities or a specific diagnosis through evaluation of the blister-cleft separation plane, the principal pathologic process, and if present, the inflammatory cell complement. Immunofluorescent and/or serologic studies are of paramount importance.
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A blister is a fluid-filled cavity within or beneath the epidermis containing tissue fluid, plasma, and a variable complement of inflammatory cells. Vesicles are blisters less than ...