General Principles:
| • | Tense blisters may become flaccid, but flaccid blisters never become tense (therefore when both are present, it is sub-epidermal) |
| • | Cannot differentiate between intraepidermal and subepidermal at acral areas because stratum corneum is thick, therefore all tense |
| • | milia with blistering disease = subepidermal (pieces of epidermis get stuck in dermis and they encyst) |
General treatment principles:
| • | continuously try to taper (to check for remission by natural history) |
| • | control: gradually increase treatment until rate of new lesion formation decreases markedly (<5 new lesions/ 3 days and old lesions healing) |
| • | consolidation: maintain dose until ~80% of lesions healed |
| • | maintenance: gradually taper to lowest dose required to maintain lesion free |
MISCELLANEOUS
Don't forget that two conditions fit neither category and can be EITHER sub-epidermal OR intra-epidermal:
| • | coma blisters |
| • | bullous diabeticorum |
Other Good Bullous Disease Lists:
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