Differential Diagnosis for Vesicular Lesions without Systemic Symptoms

• Single most likely diagnosis
  • Herpes Simplex Virus (HSV) infection: This is a common cause of vesicular lesions, particularly on the lips (cold sores) or genital areas, and typically does not present with systemic symptoms in immunocompetent individuals.
• Other Likely diagnoses
  • Varicella-Zoster Virus (VZV) infection (shingles): Although it can present with systemic symptoms, in some cases, especially in immunocompetent individuals, the symptoms might be localized and mild.
  • Contact Dermatitis: Certain types of contact dermatitis, like those caused by poison ivy, oak, or sumac, can present with vesicular lesions without systemic symptoms.
  • Dyshidrotic Eczema: Characterized by small, itchy blisters on the hands or feet, often without systemic symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
  • Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN): Although these conditions typically present with systemic symptoms and are more severe, early stages might not, and they are medical emergencies.
  • Primary Herpes Simplex Virus infection in immunocompromised patients: While HSV is common, its presentation in immunocompromised individuals can be severe and atypical, potentially leading to serious complications.
• Rare diagnoses
  • Pemphigus Vulgaris: An autoimmune disease causing blistering of the skin and mucous membranes, which can present with vesicular lesions but is less common.
  • Bullous Pemphigoid: Another autoimmune blistering disease, typically affecting older adults, which can present with large blisters but is less likely than other diagnoses.
  • Dermatitis Herpetiformis: A skin manifestation of celiac disease, characterized by intensely itchy blisters, which is less common and might not be immediately considered without a history of gastrointestinal symptoms or known celiac disease.