Not all that blisters is infectious

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Figure 1.
Polycyclic eruption of vesicles in the classical string-of-pearls pattern on the patient’s upper back
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Figure 2.
Fluorescence microscopy of the linear deposition of immunoglobulin A along the basement membrane in chronic bullous disease of childhood

Table 1.

Key features and differential diagnoses of CBDC

FEATURE	DESCRIPTION
Clinical presentation	Average age of pediatric patients with CBDC is 4.5 y; neonatal cases have been described Patient presents with tense clear or hemorrhagic blisters and vesicles 0.3 to 2.0 cm in diameter; new blisters may form near previous erosions (string-of-pearls or crown-of-jewels sign) Cases with blisters solely in the genital area have been described
Differential diagnoses for blistering in children	Other autoimmune bullous disease: pemphigus vulgaris, dermatitis herpetiformis, bullous pemphigoid, epidermolysis bullosa acquisita, bullous lupus Bacterial infections: bullous impetigo, staphylococcal scalded skin syndrome Viral infections: herpes simplex virus, varicella zoster virus Mechanical trauma: sucking blisters, friction blisters Bites: arthropod, bullous scabies Inflammatory disease: bullous mastocytosis, bullous lichen sclerosus, bullous lichen planus Genetic disease: epidermolysis bullosa, porphyria, incontinentia pigmenti
Histology	Subepidermal blister with neutrophils and occasional eosinophils in the papillary dermis
Immunofluorescence	Striking linear deposition of IgA along the basement membrane; IgG, IgM, and C3 may also be present as weaker bands