BULLAE, HEMORRHAGIC AUTOIMMUNE DISEASES, AND DISEASESOF IMMUNE DYSFUNCTION Allergic contact dermatitis to poison ivyBullous pemphigoid Clin

Exp Dermatol 13:242243, 1988 Cicatricial pemphigoid including hemorrhagic bullae of buccalmucosae;adult or childhood form of cicatricial pemphigoidDermatitis herpetiformis JAAD 16:12741276, 1987 Epidermolysis bullosa acquisita, including buccal mucosa JAAD 11:820832, 1984 Graft vs.host diseaseLinear IgA disease (chronic bullous disease of childhood) perioral, eyelids, ears, scalp, perineum, vulva;annular polycyclicbullae;hemorrhagic bullae Ped Derm 15:108111, 1998; neonatal linear IgA disease Ped Derm 10:171176, 1993 Lupus erythematosus systemic lupus bullous sunburnreaction Rook p.24722473, 1998, Sixth Edition;BJD 82:125128, 1970;AD 83:910914, 1961 Mixed connective tissue disease with vasculitisMorphea Cutis 44:118119, 1989 Pemphigus vulgarisRheumatoid vasculitis JAAD 53:191209, 2005;BJD 147:905913, 2002;AD 125:11011104, 1989 CONGENITAL LESIONS Aplasia cutis congenital Ped Derm 21:150153, 2004 DRUG-INDUCED

Bullous pemphigoid penicillin, sulfasalazine, topical5fluorouracil, PUVA, electron beam radiotherapy Clinics in Derm 11:515520, 1993 Chemotherapy extravasationCoumarin necrosis associated with protein C deficiency(autosomal dominant);begins 35 days after commencingcoumarin therapyFixed drug reactionGemcytabine extravasationHeparin necrosis BULLAE, HEMORRHAGIC99 Iododerma Australas J Dermatol 28:119122, 1987 Linear IgA disease somatostatin, vancomycin, captopril,phenytoin, lithium, diclofenac, cefamandole, amiodarone,furosemide JAAD 41:103105, 1999;Clinics in Derm 11:529533, 1993 Penicillamine hemorrhagic bullae of dorsum of feet AD 95:196198, 1967 PPD reaction bullousVasculitis, leukocytoclastic druginduced INFECTIONS AND/OR INFESTATIONS Aeromonas sobriaPathol Int 49:541546, 1999 Anthrax Bacillus anthracis ;malignant pustule;face, neck,hands, arms;starts as papule then evolves into bulla on redbase;then hemorrhagic crust with edema and erythema withsmall vesicles;edema of surrounding skin Am J Dermatopathol 19:7982, 1997;J Clin Inf Dis 19:10091014, 1994;Br J Opthalmol 76:753754, 1992;J Trop Med Hyg 89:4345, 1986; Bol Med Hosp Infant Mex 38:355361, 1981 Aspergillosis primary cutaneous

JAAD 38:797798, 1998; primary cutaneous aspergillosis in premature infants Ped Derm 19:439444, 2002;AD 136:11651170, 2000;JAAD 12:313318, 1985; sepsis in leukemic patients AD 141:633638, 2005 Brucellosis Capnocytophagia canimorsus Caterpillar dermatitis puss caterpillar (larval stage of flannelmoth, Megalopyge opercularis ) hemorrhagic papulovesicles orbullae Cutis 71:445448, 2003 Clostridium perfringens/septicumAnn Emerg Med 10:312314,1981 Cowpox papule progresses to vesicle to hemorrhagic vesicleto umbilicated pustule, then eschar with ulcer JAAD 44:114,2001;BJD 1331:598607, 1994 Ecthyma gangrenosum Pseudomonas Enteric rods Aeromonas hydrophila Xanthomonas maltophila Aspergillus species Candida albicans Capnocytophaga canimorsus Enterobacter cloacaeJAAD 27:637638, 1992;Rev Infect Dis 44:1328, 1982 Erysipelas, bullous Flavobacterium odoratum necrotizing fasciitis J Clin Inf Dis 21:13371338, 1995 Gonococcemia periarticular lesions appear in crops withred macules, papules, vesicles with red halo, pustules,

bullaebecoming hemorrhagic and necrotic;suppurative arthritis andtenosynovitis Ann Intern Med 102:229243, 1985;NEJM 282:793794, 1970 Herpes simplexHerpes zoster Tyring p.133, 2002 ImpetigoInsect bite reaction Rook p.14251426, 1998, Sixth Edition; mosquitoes The Clinical Management of Itching;Parthenon; p.64, 2000 Klebsiella sepsisLeprosy erythema nodosum leprosum AD 132:14321434,1996; nerve involvement plantar hemorrhagic bulla Rook p.1228, 1998, Sixth Edition Lyme disease NEJM 321:586596, 1989;AD 120:10171021,1984 Meningococcemia acute or chronic (petechial);acute;initiallyecchymoses, purpuric papules and plaques with surroundingerythema, vesicles, bullae, hemorrhagic necrosis, purpurafulminans Textbook of Neonatal Dermatology, p.195, 2001Morganella morganiiJAAD 12:575576, 1985 Mosquito bite hypersensitivity syndrome in EpsteinBarrvirusassociated natural killer cell leukemia/lymphoma clear orhemorrhagic bullae with necrosis, ulceration and scar formation JAAD 45:569578, 2001 Necrotizing fasciitis AD 138:893898, 2002 Nocardia asteroidesAD 121:898, 1985

Orf AD 126:356358, 1990;Isr J Med Sci 24:5456, 1988 Papular purpuric gloves and socks syndrome J Dermatol 29:371375, 2002 Pneumococcal cellulitis AD 132:8186, 1996 Portuguese man of war Proteus mirabilis Pseudomonas sepsisPurpura fulminans variety of bacterial, fungal, and viralorganisms SalmonellaNY State J Med 81:16391641, 1981 Sea anemone stingSmallpoxSnake biteSpider bites brown recluse spider bite Clin Inf Dis 32:595,636637, 2001 Staphylococcal sepsisSubacute bacterial endocarditisTropical ulcer (phagedenic ulcer) mixed infection with Fusobacterium ulcerans and other organisms;papule or bulla(hemorrhagic) which breaks down to form ulcer withundermined border Int J Dermatol 27:4953, 1988 Typhoid feverVaricella Vibrio cholerae non-01 Clin Inf Dis 21:13301333, 1995 Vibrio vulnificusClin Inf Dis 40:718,754755, 2005; AD 122:818820, 1986 INFILTRATIVE DISORDERS Amyloidosis the separation of epidermis and dermis occurswithin the dermal deposits of amyloid;protein AL consistsof a polypeptide of light chain immunoglobulin composed offragments of the variable (amino-terminal) region;clinicallesions include petechiae, purpura, ecchymoses,

plaques,tumefactive lesions, pigmentary changes, sclerodermalikeinfiltration, bullae, alopecia, cord-like blood vessel thickening,nail dystrophy, and cutis laxa Eur J Dermatol 10:139142,2000;Medicine 24:124128, 1994;Cutis 43:346352, 1989; AD 124:16831686, 1988;BJD 113:8595, 1985;AD 117:782784, 1981; oral hemorrhagic bullae Rook p.3056,1998, Sixth Edition Langerhans cell histiocytosis purpuric vesicles JAAD 37:314317, 1997;JAAD 13:481496, 1985 Mastocytosis bullous mastocytosis presents before age of9 months;occurs in absence of pigmentary changes andwithout lesions of urticaria pigmentosa;if present in infancy,extracutaneous involvement is common Ped Derm 19:375381,2002;AD 127:10491054, 1991;AD 101:547562, 1970 100A CLINICIAN S GUIDE TO DERMATOLOGIC DIFFERENTIAL DIAGNOSIS, VOLUME 1 BULLAE, HEMORRHAGIC101 INFLAMMATORY DISORDERS Erythema multiforme with epidermal necrosisPyoderma gangrenosum, bullous BJD 102:235237, 1980; Trans St John s Hosp Dermatol Soc 60:142151, 1974; association with polycythemia vera Clin Exp Dermatol 12:375377, 1987; leukemia

JAAD 9:751758, 1983; CML Proc R Soc Med 67:12391240, 1974; hairy cell leukemia JAAD 11:300302, 1985 METABOLIC Acrodermatitis enteropathicaCryoglobulinemia mixed cryoglobulinemia secondary tohepatitis C infection Cutis 72:290,295, 2003 Diabetic bulla intraepidermal or subepidermal separationwithout acantholysis JAAD 7:427455, 1982 Disseminated intravascular coagulation obstetriccomplications, extensive tissue damage, gramnegativesepticemias, immune reactions, malignancy, snake bites,angiomas, protein S or protein C deficiency Br Med J 312:683687, 1996;BJD 88:221229, 1973 Hyperhomocysteinemia and antiphospholipid antibodies JAAD 49:S161163, 2003 Neonatal purpura fulminans ecchymoses of limbs at sites ofpressure in first day of life;enlarge rapidly, hemorrhagic bullaewith central necrosis;homozygous protein C or protein Sdeficiency Semin Thromb Hemost 16:299309, 1990 Paroxysmal nocturnal hemoglobinuria petechiae, ecchymoses,red plaques which become hemorrhagic bullae with necrosis;lesions occur on legs, abdomen, chest, nose, and ears;deficiency of enzymes decayaccelerating factor (DAF) andmembrane inhibitor of reactive lysis (MIRL);acquiredintravascular hemolytic anemia;due to a drop in pH of serumduring sleep;Ham test (acid hemolysis);sucrose lysis test, lowleukocyte alkaline phosphatase;anemia, hemoglobinuria

(darkurine), increased serum hemoglobin, hemosiderinuria;abdominalpain, recurrent infections, headache, venous thrombosis,progressive bone marrow failure, and ultimately lymphoreticularmalignancy (especially, leukemia) AD 138:831836, 2002; AD 122:13251330, 1986;AD 114:560 563, 1978 Pellagra Cutis 69:9698, 2002;Semin Dermatol 10:282,1991 Porphyria cutanea tarda (PCT)Pseudo-PCTRenal failure with or without furosemideScurvy JAAD 41:895906, 1999 Wilsons disease JAAD 21:1030, 1989 NEOPLASTIC DISEASES Congenital self-healing reticulohistiocytosis JAAD 48:S7577,2003 Lymphoma cutaneous T-cell lymphoma Bull Soc Fr Derm Syph 73:373376, 1966 PARANEOPLASTIC DISEASES Paraneoplastic pemphigus BJD 144:12551261, 2001 PHOTOSENSITIVITY DISORDERS Hydroa vacciniforme red macules progress to tender papules,hemorrhagic vesicles or bullae, umbilication and crusting;pock-like scars Ped Derm 18:7173, 2001;JAAD 42:208 213,2000;Dermatology 189:428429, 1994;JAAD 25:892 895,1991;JAAD 25:401403, 1991;BJD 118:101108, 1988; AD 118:588591, 1982; familial

BJD 140:124126, 1999; AD 114:11931196, 1978;AD 103:223224, 1971; late onset BJD 144:874877, 2001 Polymorphic light eruptionSunbed use BMJ 296:1708, 1988 PRIMARY CUTANEOUS DISEASE Angina bullosa hemorrhagica AD 135:593598, 1999 Balanitis xerotica obliterans JAAD 37:124, 1997 Benign hemorrhagic bullous stomatitis Ann DV 126:525526,1999 Dariers disease of the hands and feet AD 89:523527, 1964 Epidermolysis bullosa, many types;EBS herpetiformis DowlingMeara begins in infancy with hemorrhagic blistersof fingers and toes JAAD 28:859861, 1993; EBS, Ognavariant autosomal dominant;plectin abnormality;seasonal blistering of hands and feet, bruising,hemorrhagic bullae, onychogryphotic first toenails Hum Hered 23:189196, 1973; epidermolysissimplex with mottled pigmentation acral blistering,hemorrhagic bullae, focal punctate keratoderma,dystrophic thick nails BJD 144:4045, 2001 Epidermolysis bullosa atrophicans generalisata mitis JAAD 12:836844, 1985 Erythema elevatum diutinum AD 132:13601364, 1996

Lichen nitidus AD 105:430431, 1972 Lichen planus, bullousLichen sclerosus et atrophicus, bullous JAAD 39:500501,1998;JAAD 10:346350, 1984 Toxic erythema of the newbornTransient acantholytic dermatosis (Grovers disease) PSYCHOCUTANEOUS DISORDERS Factitial dermatitis SYNDROMES Antiphospholipid antibody syndromeBehets disease JAAD 36:689696, 1997 Ichthyosiform dermatosis with superficial blister formation andpeeling JAAD 34:379385, 1996 Kindlers syndromeReflex sympathetic dystrophy (bullae on dorsal foot) JAAD 28:2932,1993 Sweets syndrome predominance of women;upperextremities, neck and upper trunk;arthralgias, conjunctivitis,episcleritis, aphthosis, proteinuria, and high ESR;1015%associated with malignancy, most commonly acutemyelogenous leukemia.In malignancy-associated Sweets,male to female ratio is 1:1 and patients more likely to havebullous or ulcerative lesions AD 126:527532, 1990 Wellssyndrome TRAUMATIC Altitude injury petechiae and hemorrhagic bullae of externalauditory canal in pilots descending from high altitudes Laryngoscope 56:225236, 1946

Burns, electrical, thermal, ultravioletComa bullae sweat gland necrosis Cutis 45:423, 1990 CryotherapyErythema ab igneFrostbitePressure bullaeSunburn VASCULAR Acquired digital arteriovenous malformation BJD 142:362365, 2000 ChurgStrauss disease BJD 150:598600, 2004;JAAD 47:209216, 2002;J Dermatol 22:4651, 1995 Disseminated intravascular coagulation (DIC)Henoch Schnlein purpura AD 139:215220, 2003;Ped Derm 15:357359, 1998;Ped Derm 12:314317, 1995 Ischemic gangrenePolyarteritis nodosa, systemic cutaneous infarcts presentingas purpuric plaques Rook p.2212, 1998 Purpura fulminansPustular vasculitis of hands JAAD 32:192198, 1995 Vasculitis large and/or small vessel leukocytoclasticvasculitis Rook p.2178, 1998, Sixth Edition; urticarial vasculitis AD 134:231236, 1998 Venous gangrene (acral) combination of severe pain,extensive edema, and cyanosis of the limb;in arterial gangreneedema is absent or minimal, cutaneous hemorrhage does notoccur, skin is pale, subcutaneous veins are poorly filled andempty with leg elevation AD 123:933936, 1987 Wegeners granulomatosis

BJD 143:207209,