Dermatological examination of bullous diseases

Physical examination in bullous diseases always comprises looking at skin and mucous membranes. Examine the skin not only for the presence of vesicles or bullae but also for other efflorescence's and typical distribution pattern. Nikolsky sign tests the resilience of the healthy-lookig skin. The mucous membranes of mouth, nose, eyes and genitals need to be examined systematically. Disease activity and extent of skin and mucous membranes can be assessed using disease activity outcome measures that are validated for pemphigus, bullous pemphigoid and mucous membrane pemphigoid.