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Red flags There are a number of bullous conditions that are potentially serious , and it important to be aware of the red flags that could suggest such a condition: Involvement of the lips and mouth and/or the rapid progression of bullae could suggest a serious drug eruption such as Stevens-Johnson syndrome or toxic epidermal necrolysis Immunobullous conditions Increasing numbers of large tense bullae could be due to bullous pemphigoid - this is very uncommon under the age of 50 years The development of blisters in pregnancy could be due to pemphigoid gestationis Involvement of mucous membranes (eyes, mouth, genitalia) could be caused by a number of immunobullous conditions such as mucous membrane pemphigoid or pemphigus vulgaris The presence of erosions and crusting with or without flaccid blisters could represent pemphigus The PEM Friends website provides a good diagnostic tool for this group of conditions Child abuse, self-harm and domestic violence - look out for an inconsistent history, as well an unusual appearance / distribution of burns or scalds It is important to note: The majority of patients that present to a health care professional with bullae will have a relatively harmless, self-limiting condition In order to make a diagnosis it is important to take a logical approach to the patient with vesicles / bullae, as described below in sections 2 & 3 2

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