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Blistering

image of a hand with dermatitis herpetiformis

This is an example of dermatitis herpetiformis, one type of blistering skin disease.

In order to understand blistering of the skin, it is helpful to understand the structure of the skin. The skin is composed of two layers, the epidermis and the dermis. The epidermis is the top layer of your skin; the dermis is the underlying connective tissue layer. The epidermis is attached to the dermis by small structures called “hemidesmosomes.” When blistering occurs, this attachment is loosened and the epidermis lifts off of the dermis, with fluid filling the resultant space. This basic mechanism is responsible for the formation of simple blisters such as a blister that occurs when a new shoe rubs against your heel.

Most blistering diseases of the skin, also known as bullous diseases because blisters are called bullae, are considered to be autoimmune diseases and develop when your immune system attacks your own tissues. They generally occur equally in men and women 40-50 years of age. These blistering autoimmune skin diseases can be separated into four groups. A fifth disease, epidermolysis bullosa simplex, is an inherited type of blistering seen in newborns and infants, which we also can treat.

Pemphigus. There are four subtypes of pemphigus. They all have a common cause which is the production of autoantibodies to components of the cell junctions that hold epidermal cells together. These cells then lose their attachments to other cells and round up, allowing the layers of the epidermis to separate; this results in blister formation.

Pemphigoid. The pemphigoid diseases, of which the prototype is bullous pemphigoid, are similar to, yet distinct from pemphigus. Bullous pemphigoid is generally seen in elderly people and appears as large, tense blisters that do not rupture easily. Antibodies develop against components of the hemidesmosomes, and separation of the epidermis and dermis occurs leading to blister formation.

Dermatitis herpetiformis. This is a rare skin disease characterized by smaller blisters (vesicles), reddened papules and occasional bullae. It is most frequently seen in males, often in association with gluten sensitivity. Blisters may improve when gluten is removed from the diet.

Epidermolysis bullosa aquisita. This is a non-genetic form of epidermolysis bullosa. It is not inherited; it is acquired later in life. Blisters occur at the sites of minor trauma, and are thought to result from antibodies being formed against anchoring fibrils present at the epidermal-dermal junction.

All of these bullous diseases are serious and some may be life threatening. Dr. Timani is a highly trained physician who can diagnose your disease by studying slides of biopsies of your skin as well as other clinical tests, and who is knowledgeable about treatment of these diseases. Her specialty training in Dermatopathology makes Johns Creek Dermatology the practice of choice in the Atlanta area for diagnosing and treating blistering diseases of the skin.