Vesiculobullous Rashes - THE ALGORITHMIC APPROACH Vesiculobullous rashes provoke significant angst in many physicians (Figure 5, page 14). However, the differential diagnosis can be greatly simplified by categorizing patients with these rashes as febrile or afebrile and noting whether the rash distribution is diffuse or localized. Patients with a diffuse vesiculobullous rash and a fever may have varicella or a more devastating illness, such as smallpox, disseminated gonococcal disease, purpura fulminans, or DIC. Necrotizing fasciitis and hand-foot-and-mouth disease present with localized lesions and fever. In afebrile patients with a diffuse vesiculobullous rash, the differential diagnosis includes bullous pemphigus (BP) and pemphigus vulgaris. These entities are regularly confused, and it is essential to differentiate urgently. However, the differential diagnosis is simpler and less emergent in a patient who is afebrile with a localized vesiculobullous rash; contact dermatitis, herpes zoster, dyshidrotic eczema, and burns (chemical or thermal) are included. #Diagnosis #Dermatology #Vesicular #Vesiculobullous #Rash #Algorithm #Differential
