Differential Diagnosis for Subepidermal Neutrophilic Rich Blister with Coexistent Folliculitis
- Single most likely diagnosis:
- Linear IgA bullous dermatosis: This condition is characterized by the presence of subepidermal blisters and is often associated with neutrophilic infiltrates. The coexistence of folliculitis could be a secondary feature due to the inflammatory nature of the disease.
- Other Likely diagnoses:
- Dermatitis herpetiformis: Although it typically presents with a more superficial blistering pattern, some cases can have subepidermal blisters. The presence of neutrophils and associated folliculitis could fit within the spectrum of dermatitis herpetiformis, especially if there's an underlying gluten sensitivity.
- Bullous pemphigoid: While bullous pemphigoid is more commonly associated with eosinophilic infiltrates, some variants can have a significant neutrophilic component. The disease can occasionally present with follicular involvement.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Staphylococcal scalded skin syndrome (SSSS): Although SSSS typically affects infants and young children, and is characterized by a more superficial cleavage, in rare cases, it can mimic other blistering diseases. The presence of folliculitis could be a clue to a bacterial infection.
- Toxic epidermal necrolysis (TEN): TEN is a severe skin condition usually triggered by medications. It can present with a variety of skin lesions, including blisters, and can involve the hair follicles. Early recognition is crucial due to its high mortality rate.
- Rare diagnoses:
- Neutrophilic urticarial dermatosis: A rare condition characterized by urticarial lesions with significant neutrophilic infiltration. It could potentially present with blistering and folliculitis in some cases.
- Sweet syndrome (acute febrile neutrophilic dermatosis): Characterized by fever, neutrophilia, and tender erythematous skin lesions, Sweet syndrome can occasionally present with blistering and could be considered in the differential diagnosis of a neutrophilic rich subepidermal blister with folliculitis, especially if systemic symptoms are present.