Differential Diagnosis for Long Bullae
- Single most likely diagnosis
- Bullous Pemphigoid: This is a common skin condition characterized by the formation of large, tense bullae (blisters) that can be several centimeters in diameter. The presence of long bullae is highly suggestive of bullous pemphigoid, especially in elderly patients.
- Other Likely diagnoses
- Pemphigus Vulgaris: Although less common than bullous pemphigoid, pemphigus vulgaris can also present with large bullae. However, these are typically flaccid and may rupture easily, leaving erosions.
- Epidermolysis Bullosa Acquisita (EBA): A rare autoimmune disorder that can cause large, tense bullae, similar to bullous pemphigoid. The clinical presentation and patient history can help differentiate EBA from other bullous diseases.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Toxic Epidermal Necrolysis (TEN): Although TEN typically presents with widespread skin necrosis and detachment rather than isolated bullae, it can occasionally start with bullous lesions. Early recognition is critical due to its high mortality rate.
- Staphylococcal Scalded Skin Syndrome (SSSS): Caused by staphylococcal toxins, SSSS can present with bullae, especially in children. It's essential to consider this diagnosis due to its potential for severe morbidity and mortality if not promptly treated.
- Rare diagnoses
- Bullous Dermatitis Herpetiformis: A rare variant of dermatitis herpetiformis, characterized by the presence of large bullae rather than the typical small, itchy blisters.
- Linear IgA Bullous Dermatosis: An autoimmune condition that can present with large, tense bullae. It's less common than bullous pemphigoid but should be considered in the differential diagnosis due to its distinct immunopathological features.