Fluid-filled Rash - Diagnostic Algorithm. Pustule: 1) Pustules more commonly suggest an infectious process (bacterial, fungal) Vesiculobullous 1) Vesiculobullous lesions are generally more concerning 2) Loss of basic structural elements maintaining cohesion between keratinocytes in the epidermis, or between the epidermal layer and the dermis (near basement membrane zone). 3) Intraepidermal blisters tend to be flaccid, fragile and thin-roofed. 4) Subepidermal blisters have a thick roof and can remain intact when compressed 5) Often due to autoantibodies targeting structural proteins in the skin.
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