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Vesiculobullous Reaction Pattern in Dermatopathology

Dr Sampurna Roy MD




Vesiculobullous reaction pattern is characterized by the presence of vesicles or bullae at any level within epidermis or at the dermoepidermal junction.

These lesions may be acquired or congenital and result from a defect in the adhesion of keratinocytes.

The three main features that should be assessed in a case of vesiculobullous lesion:

1. Anatomical level of the split ; 

2. Mechanism responsible for the split ;

3. Inflammatory cellular component.


Subcorneal Split 

- Impetigo

-Pemphigus Foliaceus

-Pemphigus Erythematosus 

-Subcorneal Pustular Dermatosis  Dermatopathology Quiz Case 92  

-Staphylococcal Scalded Skin Syndrome


Intradermal Split 

- Spongiotic blistering disease

- Viral blistering disease - Example: Herpes Infection

- Palmoplantar pustulosis


Suprabasal Split 

-Pemphigus vulgaris 

-Darier's disease Dermatopathology Quiz Case 111   

-Grover's disease Dermatopathology Quiz Case 71

-Hailey-Hailey Disease ;   Dermatopathology Quiz Case 46



Subepidermal Split with little Inflammation

-Epidermolysis bullosa 

-Bullous pemphigoid

-Toxic epidermal necrolysis


Subepidermal Split with Eosinophils 



Bullous Pemphigoid

-Herpes gestationis

-Arthropod bite 

-Drug reaction  


Subepidermal Split with Neutrophils


-Dermatitis herpetiformis
Dermatopathology Case 37

-Linear IgA bullous dermatosis

-Cicatricial pemphigoid

-Bullous SLE


 Subepidermal split with Lymphocytes 

-Erythema Multiforme  Dermatopathology Case 57 

-Bullous fixed drug eruption  Dermatopathology Quiz Case 58

-Fungal infection

-Polymorphous light eruption



Subepidermal Split with Mast cell 

-Bullous urticaria pigmentosa





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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