Differential Diagnosis

blister or bulla is a raised lesion greater than 0.5 cm in diameter containing initially clear fluid.

No. Disease Definition Sign Picture

1. Epidermolysis The blistering occurs as a Present at
bullosa direct result of trauma to birth
a fundamentally Positive
abnormal skin such that family
the epidermis does not history
fit together properly with Induced by
the dermis because of an trauma
absence or deficiency of
a vital structure such as
anchoring fibrils or
filaments. It is usually
present at birth and over
areas of skin which are
subjected to trauma and
pressure. There is
frequently a family
history of the condition.
2. Acute The skin is itchy and the Itchy
eczema (dermatitis) eruption consists of vesicles
vesicles which become which
confluent forming become
blisters. Acute dermatitis confluent
is usually the result of forming
contact dermatitis or an blisters,
acute pompholyx. weep and
then crust
3. Impetigo As the blisters break, the Children and
honey-coloured pus youths
becomes crusted and Spread
dominates the physical rapidly
signs. Golden oozing Form yellow
material is still visible, crusts
however. Staphylococcus
aureus is the commonest
cause but a ß-haemolytic
streptococcus or both
may be responsible.
4. Herpes simplex The vesicles occur in a Grouped
group on an vesicles on a
erythematous red base
background. The fluid is
initially clear, and then
becomes turbid and
subsequently crusted.
5. Herpes Zoster The eruption is clearly Vesicles in
unilateral and in this the
patient the front and distribution
back views show the of a
distribution to be that of dermatome
the cutaneous nerve TI.
Note the sparsely
scattered satellite
lesions, particularly on
the back.

6. Dermatitis The lesions may be Very itchy

herpetiformis described as blisters but Symmetrical
often are smaller vesicles grouped
which are so intensely papules or
itchy that the roof is vesicles
scratched off. The lesions Buttocks,
are grouped (hence knees,
herpetiformis) and elbows,
symmetrical on the scalp
elbows, knees, buttocks
and scalp.
7. Insect bites The blisters are itchy and Very itchy
usually associated with Grouped
urticarial lesions lesions
occurring in a grouped especially at
manner around the ankles
ankles.
8. Burn These are amongst the Blisters arise
commonest causes of at site of
blisters. Their causation burn
is usually self evident, in
this case sunburn.

Complication

Complication of Varicella

Pada anak biasanya jarang terjadi komplikasi, paling sering terjadi komplikasi karena secondary bacterial
infection (Staphylococci atau Streptococci) yang dapat menyebabkan impetigo, furuncles, cellulitis,
erysipelas dan gangrene. Infeksi biasanya hanya menyebabkan scarring, dan sangat jarang menyebabkan
organ lain terkena. Secondary bacterial pneumonia, otitis media, dan suppurative meningitis jarang
terjadi apabila diberikan terapi antibiotik yang benar. Namun, superifeksi bateri biasa terjadi pada
seseorang yang memiliki leukopenia, bahkan dapat mengancam jiwa.

Pada orang dewasa, demam dan constituional symptoms lebih lama terjadi, rash dari varicella lebih
banyak, komplikasi juga lebih sering terjadi. Primary varicella pneumonia merupakan komplikasi paling
sering terjadi pada seseorang dengan komplikasi varicella. Komplikasi nya seperti severe respiratory
embarrassment disertai dengan batuk, dyspnea, tachypnea, high fever, pleuritic chest pain, cyanosis,
dan hemotypsis yang terjadi 1-6 hari setelah munculnya rash. Tingkat kematian varicella pneumonia
cukup tinggi sekiitar 10-30%. Varicella saat kehamilan sangat bahaya baik untuk ibu maupun janinnya.
Morbidity dan mortalitynya pun meningkat terhadap pasien dengan immunocompromised.

Complication of Herpes Zoster

Komplikasi pada herpes zoster dapat dibagi menjadi beberapa yaitu cutaneous, ocular, neurologic, dan
viceral. Kebanyakan komplikasinya itu berhubungan dengan penyebaraan VZV dari termpat awal
menginfeksinya lalu menyebar ke sensory ganglion, nerve, attau skin melewati bloodstream ataupun
bisa dengan direct neural extension. Dermatomal rash akan terlihat sangat luas dan menyebar pada
pasien dengan immunocompromised sehingga dapat menyebabkan superficial gangrena dengan
delayed healing dan subsequent scarring.

Komplikasi pada mata terjadi sekitar 20-70% pasien dengan opthalamic zoster. Acute retinal necrosis
(ARN) juga merupakan penyebab utamanya adalah VZV.

Herpes zoster juga menyebabkan beberapa komplikasi pada neurologic, yang paling penting dan utama
adalah PHN. Faktor resiko paling penting untuk terjadinya PHN adalah usia, faktor lainnya sseperti
adanya prodromal oain, severe pain during acute phase of herpes zoster, greater rash severity, more
extensive asensory abnormality. Patients with PHN may suffer from constant pain (described as
“burning, aching, throbbing”), intermittent pain (“stabbing, shooting”), and/or stimulus-evoked pain,
including allodynia (“tender, burning, stabbing”). Allodynia (pain elicited by stimuli that are
normally not painful) is a particularly disabling component of the disease that is present in
approximately 90% of patients with PHN. Patients with allodynia may suf-fer severe pain after
even the lightest touch of the affected skin by things as trivial as a breeze or a piece of clothing. These
subtypes of pain may produce disor-dered sleep, depression, anorexia, weight loss, chronic

fatigue, and social isolation, and they often interfere with dressing, bathing, general activity,
traveling, shopping, cooking, and housework.

Treatment

Treatment of Varicella
Treatment of Herpes zoster

Prevention