Vesiculobullous Reaction Pattern This reaction pattern can involve both the epidermis and the dermis but essentially it is only the upper dermis and the undersurface of the dermo epidermal junction.Vesicles can form in the epidermis from severe spongiosis in eczema or because of epidermal cell necrosis from blistering viral infections such as herpes simplex or zoster or chickenpox. Bacteria can also cause blisters in the upper epidermis by lifting the stratum corneum from toxin damage or antibodies can break down the desmosomes between epidermal cells causing blisters or erosions as in pemphigus vulgaris.
However the classical blistering diseases occur because of damage at the basement membrane or the dermoepidermal junctional complex holding the two areas together.
