Bullous Lesions Research Articles

Effectiveness of Debridement Treatment in Neonatorum Epidermolysis Bullosa: A Case Report

Introduction: Epidermolysis Bullosa (EB) is an autosomal genetic disorder that characterized by blistering of the skin and mucosa following mild trauma such as frictional trauma. There is no definitive treatment has yet to be developed. The goal of surgical debridement is to achieve a clean wound bed in fastest way, reduce bacterial burden, remove as much nonvital tissue, speed up the healing process, which will shorten the length of stay in hospital. Case Finding: We have 3 days old newborn with clinical appearance similar to a second degree burn lesion bullous lesions and epidermal damage on her both feet, gluteal, and genital regions but without previous history of contact with thermal trauma consulted to patients. General physical examination showed no fever and vital within normal condition. In the perinatal history, the baby was delivered by caesarean section from a 37 years-old G3P2A0 mother with preeclampsia comorbid, normal gestational age, her birth weight was 3800 grams, her birth length was 51 cm, and with APGAR her scores of were 9 and 10 the 1st and 5th minute respectively. Our newborn patient was looked like 2nd degree burn injury with blisters and epidermolysis but without previous history of contact with thermal trauma. Consulted to plastic surgeon for further evaluation and management. The Baby was discharged day 9 or after 3 days debridement management in stable condition. Conclusion: The surgical debridement demonstrated greatly effective and efficient in achieving these aims. Observation on day 3 did not reveal any sign of infection, showing controlled symptoms and good healing process. We suggest that performing debridement on Epidermolysis Bullosa (EB) patient would shorten the duration of hospitalization. Therefore, it provides low-risk nosocomial infection and low-cost hospitalization.

Updated S2 K guidelines for the management of bullous pemphigoid initiated by the European Academy of Dermatology and Venereology (EADV).

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease of the skin and mucous membranes. This disease typically affects the elderly and presents with itch and localized or, most frequently, generalized bullous lesions. A subset of patients only develops excoriations, prurigo-like lesions, and eczematous and/or urticarial erythematous lesions. The disease, which is significantly associated with neurological disorders, has high morbidity and severely impacts the quality of life. The Autoimmune blistering diseases Task Force of the European Academy of Dermatology and Venereology sought to update the guidelines for the management of BP based on new clinical information, and new evidence on diagnostic tools and interventions. The recommendations are either evidence-based or rely on expert opinion. The degree of consent among all task force members was included. Treatment depends on the severity of BP and patients' comorbidities. High-potency topical corticosteroids are recommended as the mainstay of treatment whenever possible. Oral prednisone at a dose of 0.5 mg/kg/day is a recommended alternative. In case of contraindications or resistance to corticosteroids, immunosuppressive therapies, such as methotrexate, azathioprine, mycophenolate mofetil or mycophenolate acid, may be recommended. The use of doxycycline and dapsone is controversial. They may be recommended, in particular, in patients with contraindications to oral corticosteroids. B-cell-depleting therapy and intravenous immunoglobulins may be considered in treatment-resistant cases. Omalizumab and dupilumab have recently shown promising results. The final version of the guideline was consented to by several patient organizations. The guidelines for the management of BP were updated. They summarize evidence- and expert-based recommendations useful in clinical practice.

Histopathological Spectrum And Role Of Clinicopathological Correlation In The Diagnosis Of Vesiculobullous Lesions.

Histopathology is an important diagnostic modality for vesiculobullous lesions, however the diagnosis may at times require use of Immunofluorescence techniques which are expensive and not widely available. The aim of this study was to determine the histopathological spectrum of vesiculobullous diseases and to determine the role of clinic-pathological correlation in diagnosing bullous lesions. This was cross sectional validation study conducted in a tertiary care hospital, over a period of 18 months. All the clinically diagnosed cases of bullous diseases were included and examined as histological sections by three histopathologists. Out of 58 total cases, the most frequently diagnosed lesions included Pemphigus vulgaris (27%), Bullous pemphigoid (13.8%) and Pemphigus foliaceous (12.1%). Females comprised 55% of cases, age distribution was wide but most patient were in age bracket of 20-39 years. There was 89.6% correlation between clinical and histopathological diagnosis. Only 2 cases were sent for Immunofluorescence studies, as histopathology was inconclusive in those cases. Therefore, we conclude that histopathological examination along with clinical correlation is a very useful way of diagnosing vesiculobullous disorders.

A Rapidly Progressive Case of Skin and Soft Tissues Necrosis in a COVID-19 Positive Patient

Sars-Cov2 infection can result in numerous and varied skin manifestations including vasculopathy, bullous lesions and rarely necrotic lesions. At present, the aetiopathogenetic mechanism is still unclear. We report a case of a 68-year-old patient with acute onset of bullous and necrotic lesions with rapid progression to osteomyelitis, suffering from mild Sars-Cov2 infection. =

Bullous pemphigoid diagnosis: the role of routine formalin-fixed paraffin-embedded skin tissue immunochemistry

The gold standard for diagnosing bullous pemphigoid (BP) is the detection of linear deposition of IgG and/or C3 at the dermoepidermal junction using direct immunofluorescence (DIF). Because DIF has several disadvantages, primarily the requirement for frozen specimens, we assessed the diagnostic value of immunohistochemical (IHC) staining for BP detection. Eighty-eight patients with bullous lesions were included in this study. IHC staining for C3d, C4d, and IgG was performed on 88 samples, which included specimens from patients with DIF-confirmed BP (n = 43), clinicopathologically suspected BP with negative DIF results (n = 9), and other bullous diseases (n = 36). Diagnosis based on positive results for C3d, C4d, or IgG in IHC staining detected 86% of DIF-confirmed BP cases. The sensitivity of IHC staining for the detection of DIF-confirmed BP cases and clinicopathologically suspected BP cases was similar to that of DIF (80.8% vs. 84.3%), but the specificity was higher (83.3% vs. 75.0%). Five of the nine clinicopathologically suspected BP cases were diagnosed using IHC staining. Thus, IHC staining of routine biopsy material could be an alternative method for diagnosing BP. IHC staining has considerable diagnostic potential, especially in cases with a high suspicion of BP, but negative or suboptimal DIF results.Please check and confirm the author names and initials are correct. Author 2: Given name: [Chul Hwan] Family name: [Kim], Author 3: Given name: [Yoo Jin] Family name: [Lee].Checked it.

Video-assisted thoracoscopic (VATS) era in surgical treatment of spontaneous pneumothorax

Background: VATS is now regarded by many surgeons to be the gold standard in the surgical management of a variety of thoracic conditions, such as spontaneous pneumothorax (SP), pleural diseases, and indeterminate lung nodules. Aim and objectives: to describe different VATS techniques in patients with spontaneous pneumothorax.Summary: Several clinical management issues remain unanswered. Firstly, the duration of prolonged air leak that warrants VATS remain controversial. Current recommendations range from five days by BTS to three days advocated by our institute with more than a decade of experience with VATS for SP. Furthermore, whether VATS should be offered to all patients with low general anesthetic risk presenting with first episode of SP is unclear. Furthermore, the evolution of surgical techniques to allow ipsilateral thoracoscopic approach to treat contralateral bullous lesion may redefine the indications for CT scan in SP. Technically, the debate will continue among the surgeons on the type of VATS procedure that will minimize pneumothorax recurrence. Most surgeons will agree that some form of bullectomy (endoscopic staple or suturing) is mandatory. However, the nature of pleurodesis (mechanical, chemical, or both) that follow is often at the discretion of the individual clinician.

Large bilateral corneal ulcers caused by debromoaplysiatoxin from the blue-green alga Lyngbya majuscula in a fisherman.

Toxic seaweed dermatitis is caused by toxins of the marine cyanobacterium Lyngbya majuscula after sea bathing in some tropical area. This rarely described irritant dermatitis results in papular and bullous lesions, mainly in the genital area but severe ocular lesions can occur.

How to decrease systemic corticosteroids in pemphigus patients under rituximab.

How to decrease systemic corticosteroids in pemphigus patients under rituximab.

Dual role of basophils in the pathogenesis of bullous pemphigoid elucidated by pathological and ultrastructural studies

Bullous pemphigoid (BP), one of the most common autoimmune blistering disorders, is characterized by early erythematous and bullous lesions. Histopathologically, eosinophilia in the dermal tissue is a common finding in BP. In addition, basophils infiltrate the BP skin lesion. Although basophils are involved in the induction of type 2 immunity along with eosinophils, their role in both the erythema and blister, as well as the chronology of their involvement, have not been investigated. To elucidate the role of basophils in BP development and resolution by performing early- and late-phase histopathological analysis of BP. A total of 25 patients with BP who underwent biopsy for both erythema and bullous lesions and were not taking oral steroids at the time of biopsy, were selected. Biopsy specimens of the erythematous (inflammatory) and bullous (resolution) phases were compared by histopathology, immunohistochemistry and electron microscopy. During the early phase of BP, the number of basophils positively correlated with the number of eosinophils compared with other immune cells. In the late phase (bullous phase) of BP, the number of basophils significantly increased and more cell-cell contact between the basophils and M2 macrophages was noted, compared to the early phase Basophils are involved in the development of BP and its resolution, in part, via cell-cell contact with eosinophils or M2 macrophages, as demonstrated by pathological analysis.

Unilateral Giant Bullous Emphysema; Vanishing Lung Syndrome

Bullous lung disease is an illness characterized by nonfunctional air-filled spaces caused by deterioration of alveolar tissue. Lung diseases such as chronic bronchitis, emphysema, and bronchiolitis are associated with smoking. We aimed to present a case of giant bullous emphysema without any known comorbidity and who was admitted to the clinic with progressive dyspnea in a short time. A 52-years-old male patient was admitted to the clinic with the complaint of increasing dyspnea in the last 3 months. Smoking was 26 pack years, and no chronic disease. Giant bullae with a size of 13x15x20 cm, starting from the right apical and extending posteriorly to the lower lobe fissure, and diffuse emphysematous pathologies were seen in the thorax CT. The patient was operated on for a giant bullous lesion that subtotally contains the upper lobe of the right lung and causes respiratory dysfunction with the compression effect on the middle lobe and lower lobe (resection of the giant bulla was operated by the right thoracotomy). Except for the operation-related pain complaint, no respiratory symptoms were seen. The patient said with an effort, respiratory distress decreased significantly. No complications were observed, and the patient was discharged on the 6th day of the operation. Vanishing Lung Syndrome is a complication of Chronic Obstructive Pulmonary Disease, and it is defined as idiopathic giant bullous emphysema. This illness defined as giant bulla occupying one-third of the hemithorax, it compresses the mediastinum and lung parenchyma. Differentiating bullous lesions of the lung from pneumothorax is important in the treatment. Surgical treatment is a successful option in symptomatic giant bullae or with compression of lung parenchyma. Bullectomy improves the patient's symptoms, pulmonary function, quality of life, and expansion of the lung parenchyma.

Sulphamethoxazole-trimethoprim induced fixed drug eruption in a patient with Chronic Granulomatous Disease.

Chronic granulomatous disease (CGD) is a known Primary immunodeficiency disease that results in recurrent, life-threatening bacterial, fungal infections and granuloma formation which requires lifelong antibacterial and antifungal prophylaxis. Sulphamethoxazole-trimethoprim (TMP-SMX/Septrin) is the prophylactic antibacterial drug of choice. 1 Adverse drug reactions, including Fixed Drug Eruption (FDE) to TMP-SMX in CGD patients, are challenging as it may result in serious complications and difficulties in management.A seventeen-year-old Qatari female diagnosed with CGD was maintained on prophylactic TMP-SMX and itraconazole since childhood. She developed bullous skin lesions involving the face, neck, and trunk sparing the limbs. The skin lesion was confirmed to be FDE by skin biopsy. TMP-SMX was discontinued as it was suspected to be the causative agent. Atovaquone 1500 mg and clarithromycin 250 mg daily were started as an alternative, but the patient could not tolerate them. TMP-SMX slow graded challenge and desensitization were performed; however, the patient developed similar lesions in the previous affected areas on day 3 of desensitization, which responded well to discontinuation of TMP-SMX along with administration of steroid. FDE to TMP-SMX as the causative agent was confirmed. An MDT meeting was conducted to evaluate other available options for treatment. Also, the case was discussed with international immunology colleagues. The recommendation was to go for bone marrow transplantation to treat the primary disease. Six years post transplants, the patient is doing well and is not on any medications apart from the hormonal replacement therapy patch.CGD predisposes to several gram-positive, gram-negative bacterial (Staphylococcus aureus, Burkholderia cepacia complex, Serratia marcescens, Nocardia species) and fungal infections. 2 TMP-SMX is an ideal antibiotic as it is relatively cheap with good coverage and orally available. In the medical literature, desensitization can be tried in FDE, especially if there is no alternative for the needed drug. FDE signs should be observed when administered TMP-SMX.

Unilateral bullous pemphigoid in a hemiplegic patient

Sir, Bullous pemphigoid (BP) is the most common autoimmune bullous dermatosis, mainly affecting the elderly. Its association with neurological diseases has been reported for several years in several studies, including with strokes. We report a new case of unilateral BP in a hemiplegic patient. A 78-year-old patient with a history of hypertensive and ischemic heart disease and ischemic stroke three years ago was admitted for pruriginous bullous dermatosis evolving for one month prior to admission. A general examination revealed right hemiplegia with facial involvement and aphasia. A dermatological examination found localized erosions on the paralyzed side of the body, without urticarial or bullous lesions. Nikolsky’s sign was absent and the rest of the clinical examination was without abnormality (Figs. 1a – 1c). A skin biopsy revealed a skin coating widely ulcerated on the surface without eosinophilic infiltrate. Indirect immunofluorescence was positive at 1260. The diagnosis of BP was retained and the patient was started on a strong local dermocorticoid with a good evolution and the disappearance of the lesions after two months.

April 2022 Critical Care Case of the Month: Bullous Skin Lesions in the ICU

No abstract available. Manuscript truncated after 150 words. History of Present Illness: A 29-year-old woman with a past medical history of lupus and prior pulmonary embolism complained of a 2-week history of nonproductive cough. The cough began after her son was diagnosed with respiratory syncytial virus (RSV). Symptoms progressively worsened and now she is admitted from the emergency department (ED) with generalized weakness and progressive shortness of breath. Earlier in the day at an outside hospital, she tested positive for RSV, negative for COVID-19 and had normal O2 saturations and was discharged home. She has not received COVID-19 vaccine. Symptoms progressed, 911 was called and in the emergency department (ED), she was found to have temperature = 104°F, SpO2 = 64% on room air, and fasting blood sugar in the 40s. She was lethargic with visible respiratory distress and unable to answer questions. Past Medical History: • Systemic lupus erythematosus • Membranous lupus nephritis • Raynaud's syndrome Mixed connective tissue disease, …

Severe Vancomycin-Induced Linear IgA Bullous Dermatosis Case Report

Linear IgA bullous dermatosis is a rare autoimmune blistering disease. Although multiple reports have documented drug exposure as a precipitating factor, formal studies validating the existence of drug-induced LABD are lacking. A 49-year-old man with history of intravenous drug use presented with left hip pain of 3 weeks duration after sustaining a fall. On presentation he was hemodynamically stable and physical examination was notable proximal left thigh tenderness with stiffness and limited range of movement. Laboratory diagnostics were remarkable for elevated inflammatory markers, with no evidence of leukocytosis. CT scan without contrast of the left lower extremity demonstrated severe left hip osteoarthritis without fracture or dislocation. The patient continued to experience severe pain, prompting incision and drainage of the left hip along with acetabuloplasty, removal of the femoral head, and stage I hip replacement with placement of prophylactic prosthetic cement spacer with vancomycin and tobramycin. Within 24 h of surgery, he developed multiple distinct maculopapular/bullous lesions of his torso and medial thigh that rapidly progressed. Punch biopsy was performed and due to involvement of ~ 20% body surface area, he was transferred to a tertiary center. H&E and immunostaining of the histological sample demonstrated linear IgA bullous disease mimicking Stevens-Johnson syndrome. The patient’s bullous lesions improved 2 weeks after discontinuation of vancomycin and initiation of therapy. This case demonstrates the importance of early recognition of the rare adverse effects of commonly used medications. Vancomycin is currently used more frequently given the recent rise in the prevalence of methicillin-resistant Staphylococcus aureus infection. Further studies are needed to understand the pathophysiology, genetic predisposition, and disease penetrance.

Unexpected Bullae in a 12-year-old Boy

Unexpected Bullae in a 12-year-old Boy

Linear immunoglobulin A bullous dermatosis with severe ocular and oropharyngeal involvement

Linear IgA bullous dermatosis (LABD) is a rare chronic autoimmune epidermal disorder that presents with bullous and vesicular lesions affecting the skin and, more rarely, oral and ocular mucosa.1 This report describes a previously well 74-year-old man on no medications who presented with 3 months of oral mucosal ulceration causing dysphagia and odynophagia, bilateral ocular irritation and injection, and 6 months of cutaneous lesions. Clinical examination revealed multiple papular erythematous skin lesions on the trunk and axilla.

Clinical Treatment for Periostomy Bullous Pemphigoid with Generalized Progression

Background: We presented an 84y/o male patient with S-colon carcinoma obstruction, he received emergent Hartmann procedure. Pathology revealed T4aN1bM0. Postoperative outpatient follows up is smooth until peri-ostomy skin lesion happened 17 months later after operation. The patient had multiple bullous erythematous painful sensation around end colostomy, and he visited other physician taken NSAID medication or anti-histamine without relief. The bullous skin lesion progressed to whole abdomen, face and upper arm.

Painful and oozing bullous lesions in a 74‐year‐old woman

Painful and oozing bullous lesions in a 74‐year‐old woman

BULLOUS SUBACUTE CUTANEOUS LUPUS ERYTHEMATOSUS. A CASE REPORT

Lupus erythematosus is an autoimmune collagen disorder with multiple organs involvement. Subacute cutaneous lupus erythematosus represents about 10% of Lupus erythematosus cases and is frequently drug induced. A 83-year-old female patient, otherwise healthy, presented for disseminated annular lesions with mild pruritus lasting for 5 days.The patient denied any new drug usage in the last two months.Laboratory findings showed raised Anti-Ro antibodies and Anti-La (SS-B). The patient received systemic corticotherapy with the remission of the lesions in one month.Subacute cutaneous lupus erythematosus can present with bullous skin lesions and can arise in elderly people without drug usage.

Disseminated tense bullae on newborn

Disseminated tense bullae on newborn