Vesiculobullous dermatoses

Abstract

The vesicobullous diseases in dermatology are numerous and quite distinct from one another; the unifying feature, intuitively, is the histologic feature of separation either intraepidermally or subepidermally. Vesicobullous diseases can be mediated through infections, allergic causes, physical insults, or may occur as a result of autoimmune and hereditary disorders. The majority of vesicobullous diseases are acquired, wherein autoantibodies target specific cellular adhesion molecules resulting in separation of keratinocytes. In contrast, inherited vesicobullous diseases due to genetic loss of either adhesion molecules or basic structural proteins, lead to loss of cell-cell adhesion following minor or insignificant trauma or traction to the skin. The term acantholysis refers to intraepidermal pathology, whereas blister is traditionally used to delineate subepidermal disease. Whether acquired or inherited, vesicobullous diseases are a major source of patient morbidity and mortality in dermatology, either due to inherent disease processes or from therapeutic complications.