Linear IgA bullous dermatosis
A number of drugs have been associated with LABD, most commonly vancomycin. Other causative agents include phenytoin, amoxicillin, NSAIDs, lithium, diclofenac, captopril, interleukin-2, interferon gamma, furosemide, and d-penicillamine.
LABD most commonly presents in the fifth decade of life, with annular or grouped vesicles or bullae, most frequently on the extensor surfaces. Mucosal erosions (which can affect any mucosal surface) are common and may be severe and result in scarring. Pruritus and burning may be associated with the eruption. Oral findings are present in 80% of cases.
Drug-induced LABD usually occurs 1-2 weeks after starting the offending medication, and resolves within several weeks of stopping the medication. It can present with more widespread bullous involvement than non-drug-induced disease. Localized or widespread macular erythema may be seen in association.
The pediatric variant of LABD, also called chronic bullous disease of childhood, usually presents before age 5 and appears as clusters or rings of tense bullae in the perioral and perineal regions.
L13.8 – Other specified bullous disorders
95330001 – Linear immunoglobulin A dermatosis dermatosis
- Drug eruption, bullous
- Epidermolysis bullosa acquisita can be difficult to distinguish but may have the additional findings of milia; biopsy with direct immunofluorescence is helpful.
- Cicatricial pemphigoid is a scarring, blistering disease that involves the mucosal surfaces.
- Pemphigoid gestationis is a variant of BP that presents in pregnant or postpartum females.
- Sneddon-Wilkinson subcorneal pustulosis
- Dermatitis herpetiformis rarely has intact bullae secondary to excoriation.
- Bullous fixed drug eruption has a history of inciting drug and usually presents with a solitary lesion.
- Porphyria cutanea tarda or pseudoporphyria presents with bullae, milia, and hypertrichosis in sun-exposed areas.
- Pemphigus vulgaris or foliaceus have flaccid (fragile) bullae.
- Insect bite reaction
- Bullae secondary to lymphedema
- Contact dermatitis with bullae
- Poison ivy dermatitis
- Bullous impetigo will have associated honey-colored crust.
- Bullous cellulitis
- Leukocytoclastic vasculitis
- Immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura)
- Older patients can get erythema multiforme (EM) from drugs or herpes infections; however, EM does not commonly present with frank bullae.
- Urticarial lesions are transient, lasting less than 24 hours.
Last Updated: 12/14/2018