There are a number of disorders that can present with vesicles and bullae, including exaggerated insect bite reactions (see Chapter 20), autoimmune and inherited blistering diseases (see Chapters 23–26), porphyrias (see Chapter 41), the Stevens–Johnson syndrome–toxic epidermal necrolysis spectrum (see Chapter 16), and phototoxicity, from sunburn to phototoxic drug reactions (e.g. due to doxycycline). This chapter examines a miscellaneous group of disorders, several of which favor the lower extremities, whereas Chapter 28 reviews vesiculobullous diseases in newborns and infants.

Edema Bullae (Edema Blisters)

• The bullae are bland (i.e. non-inflammatory), initially tense, and may reach several centimeters in diameter; they arise within areas of significant edema and contain sterile, usually clear but occasionally blood-tinged, fluid.

• The most common location is the distal lower extremities, often in the setting of an acute exacerbation of chronic edema in an elderly patient; in patients with anasarca and those who are bedridden, the distribution can be more widespread (Fig. 27.1).

Fig. 27.1 

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