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55 old male k/c/o dm had lesion on lower limbs then gradually spreaded to whole body, consulted dermatologist gave him mometasone creams and some oral anti itching, but no relief since 10 days lesions fill with water and then they drain themselves, it is not chocken pox as not all lesion are watery Sharing photos pls gove diagnosis

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bullous pemphigoid AND diagnosis

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American Academy Dermatology bullous pemphigoid diagnosis blisters urgent symptoms

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https://www.aad.org/public/diseases/a-z/bullous-pemphigoid-t…

The photos show scattered red itchy papules, some with central crusting/excoriation. I cannot confirm active fluid-filled blisters in these images. With the history of severe itch, lesions beginning on the legs and spreading, and some becoming fluid-filled then rupturing, this is not possible to diagnose safely from photos alone.
The important possibilities include:
  1. Bullous pemphigoid - an autoimmune blistering disorder that commonly occurs after age 60 and may start with itchy red bumps/welts before tense blisters appear. This is a significant concern when new blisters are widespread. Diagnosis requires skin testing, not visual assessment alone. Fitzpatrick's Dermatology, p. 976. The AAD overview advises dermatology assessment because untreated disease can lead to infection and serious complications.
  2. Scabies with an allergic/blistering reaction - can cause very itchy papules, vesicles, and sometimes bullae, often affecting the waistline, wrists, finger webs, groin, buttocks, ankles, and family contacts. A clinician should look for burrows and examine/scrape the skin. Dermatology 2-Volume Set, 5e, p. 560.
  3. Insect-bite hypersensitivity, folliculitis, or another dermatitis - these can look similar, but do not explain persistent new blisters without an examination.
  4. Diabetic bullae are less likely from this description because they usually produce painless, larger tense blisters on normal-looking skin of feet/lower legs/hands, rather than an intensely itchy generalized papular eruption. Dermatology 2-Volume Set, 5e, p. 560.

What to do today

  • Arrange urgent dermatology review within 24-48 hours, preferably sooner if new blisters are continuing.
  • Ask specifically for:
    • A biopsy of a fresh blister for routine histology.
    • A biopsy of normal-looking skin right beside a blister for direct immunofluorescence.
    • BP180/BP230 antibody testing if bullous pemphigoid is suspected.
    • Dermoscopy/skin scraping for scabies if the distribution or household history suggests it. A blistering disorder such as pemphigoid is confirmed using biopsy and immunofluorescence, as described by DermNet.
  • Take a complete list of medicines. In particular, tell the dermatologist if he uses a diabetes medicine ending in -gliptin, such as sitagliptin, linagliptin, vildagliptin, or saxagliptin, since these can be associated with bullous pemphigoid. Do not stop prescribed diabetes medicines without the treating clinician’s advice.
  • Do not puncture blisters. Keep ruptured areas gently clean, cover with a non-stick sterile dressing, and avoid scratching. Avoid adding more steroid creams or antibiotic tablets on your own until reviewed.

Go to emergency care now if

There is fever, weakness, rapidly spreading redness/warmth, pus, severe pain, extensive skin peeling, blisters in the eyes/mouth/genitals, or poor glucose control. Diabetes increases the risk of a skin infection becoming serious.
This does not look classically like chickenpox in the photos, but a dermatologist must examine fresh lesions to distinguish the above conditions.
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