Bullous Disorders of Childhood

Abstract

Bullous diseases, both inherited and autoimmune, may be encountered on the inpatient consultation service. Neonates may be born with blisters and it is important to be aware of first and foremost the importance of ruling out an infectious process. The family history and morphology of the lesions may provide important clues to the diagnosis. Once infection has been ruled out, in cases without a family history of bullous disease, the autosomal recessive forms of genetically inherited blistering disease such as epidermolysis bullosa although rare, are more common than the autoimmune bullous disease in neonates. Acquired forms of blistering in the category of autoimmune remain rare, but become more common as children mature. Sudden presentations of large acral blisters in infants should prompt consideration of infantile bullous pemphigoid after hand-foot-mouth disease or other infection is ruled out. Linear IgA bullous disease, also known as chronic bullous disease of childhood, is often initially mistaken for impetigo and although may be superinfected and partially respond to oral antibiotics, the diagnosis may only become clear with the clinical course or the astute clinician recognizing and initiating a workup for the condition. Regardless of the cause of the blisters, careful wound care with non-adherent dressings and monitoring for signs or symptoms of superinfection must be performed.