Megan Noe, MD: Better Identifying, Diagnosing Blistering Disorders

For another segment of her HCPLive interview, Megan Noe, MD, MPH, MSCE, known for her work as Associate Professor of Dermatology at Brigham and Women’s Hospital in Boston, discussed major takeaways from her talk ‘Diagnosis and Management of Blistering Disorders.’

This presentation was held at the Society of Dermatology Physician Assistants (SDPA) 2023 Annual Summer Dermatology Conference in Boston.

“So I think one of the main factors is sort of understanding the distribution of blisters,” Noe explained. “So where the blisters are located can tell us a lot about or sort of lead us in the right direction of the cause. For example, there are certain types of blisters that only occur in dependent areas or in the feet. If I just see big asymptomatic blisters in the feet or lower legs, then I'm thinking of an edema blister secondary to chronic edema.”

She then expressed that it may be related to diabetes, or what is called bullous diabeticorum.

“If I see blisters and unexposed distribution, it can be an allergic contact dermatitis may be exacerbated by the sunlight,” she said. “I think a lot of people are common. We are familiar with allergic contact dermatitis to poison ivy. But that's another good one where you sort of see the distribution blisters, in like the shape of vines on legs or arms, things that would be exposed, it sort of gives us a clue to what might be the cause of the blister.”

Noe also expressed that, in her view, a lot of the infectious causes of blistering can sometimes give clinicians a clue about the condition.

“I include a little bit of information about shingles in my talk,” she said. “So we think about shingles and being dermatomal and never crossing the midline. Whereas primary chickenpox or primary varicella or disseminated zoster can have a similar looking primary lesion but would be widely distributed all over.”

“Especially when we're talking about disseminated zoster that's in a specific patient,” she added. “So typically in someone who's broadly immunosuppressed from a stem cell transplant, or a person who's undergoing chemotherapy. I think it's really important to pay attention to all these little clues, the distribution, the specific patient, and that helps the differential go from broad to fairly narrow kind of quickly.”

Noe then described the importance of her talk for dermatologists in the field who may be presented with patients like these.

“I think in general, it's important because blisters are so common,” she said. “So a lot of the things that I talked about in the talk are very common things that people are aware of, and things that probably people are very familiar with, like edema blister, allergic contact dermatitis that results in blisters bullous impetigo, and I mentioned Zoster previously. Those things are very common.”

She added that in her view, her presentation could be a good reminder to think about these things for those in the dermatology field.

“I think it's also helpful at big annual meetings to sort of remember all the uncommon things, so my talk includes a lot of pictures,” she said. “I hope that even when people are hearing about the more common things, maybe the picture that I show is just another example of something that will sort of help build people's clinical recognition.”

View the HCPLive interview segment above to find out more about Noe’s presentation.

In his article, quotes included were edited for clarity.