Blistering Rash over Broken Ribs

Kathleen R Graham,Victor J Marks,Bethany R Rohr

doi:10.25251/skin.4.5.11

Kathleen R Graham, Victor J Marks + Show 1 more

Open Access

https://doi.org/10.25251/skin.4.5.11

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Abstract

Fracture blisters are painless fluid-filled bullae most commonly located over fractures of the distal tibia and humerus. They are diagnosed clinically. Invasive procedures and treatments increase the risk of wound infection and should be avoided. While there is no consensus on management, evidence supports leaving the blisters intact and treating erosions with topical barrier ointments or topical antibiotics. We present a rare case of a 55-year-old man with fracture blisters located superficial to trauma-induced rib fractures that were successfully treated with topical mupirocin.

Highlights

Fracture blisters are the result of skin separation with fluid collection at the dermal epidermal junction (DEJ)
We present a case of a 55-year-old man with fracture blisters found in a previously undocumented location
Routine bacterial culture and viral polymerase chain reaction for Varicella-zoster virus and Herpes simplex virus types 1 and 2 from the base of a ruptured bulla were negative, and the patient was diagnosed with fracture blisters

Summary

INTRODUCTION

Fracture blisters are the result of skin separation with fluid collection at the dermal epidermal junction (DEJ). These bullae are an uncommon complication of fractures. The patient reported that the blisters were not initially present at the time of injury but were noticed the morning at the time of this encounter. Routine bacterial culture and viral polymerase chain reaction for Varicella-zoster virus and Herpes simplex virus types 1 and 2 from the base of a ruptured bulla were negative, and the patient was diagnosed with fracture blisters. The. pneumothorax and pulmonary contusion suggests a high-energy trauma, which placed him at higher risk for developing fracture blisters. Certain comorbidities that impair skin integrity can further contribute to fracture blister formation- including smoking, alcoholism, and diabetes mellitus.[1,4] Trauma patients often have multiple comorbidities placing this population at a higher risk for fracture blister development.[7]

DISCUSSION

CONCLUSION