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June 2013

Hemorrhagic and Serous-Filled Vesicles and Bullae—Diagnosis

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD; LORI D. PROK, MD

JAMA Dermatol. 2013;149(6):751-756. doi:10.1001/jamadermatol.2013.3314f

Hematoxylin-eosin staining showed a subepidermal vesicle with a sparse superficial perivascular infiltrate of lymphocytes and rare eosinophils. Direct immunofluorescence revealed a nonspecific granular fluorescence with fibrinogen along the dermal-epidermal junction (DEJ). The patient was treated with loose gauze and silver sulfadiazine. His fracture was repaired without event.

Fracture blisters, largely studied in the orthopedic literature, are notably underreported in the dermatology literature. Occurring in 2.7% of patients with acute hospitalized fractures,1 fracture blisters are thought to result from skin strain during fracture deformation,2 the areas most prone having the least subcutaneous support (ie, the distal tibia and elbow). Postfracture edema, as well as hypoxia from injured vessels and lymphatics contributes to vesicle formation, seen histologically as a subepidermal split at the DEJ.1

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