Vesicular, bullous and pustular disorders in infancy and childhood

The vestibular, bullous and pustular disorders of the neonate, infant and child comprise a fascinating array of diseases to challenge the diagnostic and therapeutic acumen of the pediatrician and dermatologist alike. A vesicle is defined as a fluid-filled elevated skin lesion that is less than 1 cm in diameter. When the lesion is larger than 1 cm in diameter, it is termed a bulla. A vesicle or bulla contains clear fluid. A vesicle or bulla containing pus rather than clear fluid is defined as a pustule. The purpose of this article is to present the pediatrician with mechanisms for clinical recognition, laboratory confirmation, and effective therapy of many of the vesicular, bullous and pustular diseases seen in the pediatric population. The transient neonatal disorders will be reviewed in considerable detail, for their recognition may spare a healthy neonate from extensive sepsis work-up, 'shotgun' antibiotic therapy, and prolonged hospitalization with its own inherent morbidity. Several chronic bullous disorders including epidermolysis bullosa, urticaria pigmentosa, and benign chronic bullous dermatosis of childhood will be carefully reviewed and the diagnostic and therapeutic approaches updated. Several vesicular bullous disorders that may occur as acute and episodic severe diseases in children, such as erythema multiforme, toxic epidermal necrolysis, and the staphylococcal scalded skin syndrome are reviewed elsewhere in this issue.