Table 2: Differential diagnoses of bullous impetigo [9].

Diagnosis Distinguishing features
Bullous erythema multiforme Vesicles or bullae arise from a portion of red plaques,
1 to 5 cm in diameter, on the extensor surfaces of extremities, an
unusual location for impetigo
Bullous lupus erythematosus Widespread vesiculobullous eruption that may be pruritic;
tends to favor the upper part of the trunk and
proximal upper extremities
Bullous pemphigoid Vesicles and bullae appear rapidly on widespread pruritic,
urticarial plaques may appear, unlike in impetigo
Herpes simplex virus Grouped vesicles on an erythematous base that rupture to
become erosions covered by crusts, usually on the lips and skin; may have
prodromal symptoms which are not usually observed in impetigo
Insect bites Bullae seen with pruritic papules grouped in areas in which bites occur
Pemphigus vulgaris Non-pruritic bullae, varying in size from one to several centimeters,
appear gradually and become generalized; erosions last for weeks
before healing with hyperpigmentation, but no scarring occurs
Stevens-Johnson syndrome Vesiculobullous disease of the skin, mouth, eyes, and genitalia;
ulcerative stomatitis with hemorrhagic crusting is the most characteristic feature.
Ulcerative stomatitis is not seen in impetigo
Thermal burns History of burn with blistering in second-degree burns
Toxic epidermal necrolysis Steven-Johnson-like mucous membrane disease followed
by diffuse generalized detachment of the epidermis.
Much more severe than impetigo
Varicella Thin-walled vesicles on an erythematous base that start on trunk and
spread to face and extremities; vesicles break and crust forms;
lesions of different stages are present at the same time in a given body
area as new crops develop