Presence Of Blisters Research Articles

Clinical Characteristics and Survival of Pemphigoid and Pemphigus Patients in a Thai Population

Objective: Pemphigoid and pemphigus are skin diseases with high morbidity and mortality. The research aims to study the clinical presentations, comorbidities, and medications used prior to diagnosis, as well as the survival rates and prognostic factors for pemphigoid and pemphigus patients. Materials and Methods: The cohort study was conducted on retrospective data of patients who were treated at Naresuan University Hospital between 1 October 2012 and 30 September 2022. Results: There were 30 pemphigoid patients and 44 pemphigus patients. Pemphigoid patients were on average older than pemphigus patients (76 years vs 52 years), have more skin blisters, and less oral cavity lesions. Neurological disease increases risk of being diagnosed as a bullous pemphigoid (odds ratio=4.6, p-value =0.051). After adjustment by neurologic disease and age at diagnosis, pemphigoid was not significantly associated with the use of any medications. The survival rate of pemphigus was 91.1% at 1 year and 82.2% at 5 years, while the survival rate of pemphigoid was 69.9% at 1 year, and 47.7% at 5 years. In multivariable Cox regression analysis, there was worse prognosis among pemphigoid and pemphigus patients that have comorbidity disease (adjusted HR= 3.13, p-value=0.057) and were older than 70 years (adj HR= 6.93, p-value=0.015). Conclusion: Clinical characteristics of bullous pemphigoid and pemphigus were different such as age of onset, presence of blister and oral lesion. Neurological disease was a risk factor for developing bullous pemphigoid than pemphigus. Survival of pemphigoid patients was worse than pemphigus patients. However, this finding could be confounded by older age of pemphigoid patients.

Delayed surface degradation in W-Ta alloys at 400 °C under high-fluence 40 eV He plasma exposure

The surface modifications in W-xTa alloys (x = 0, 6, 11 wt.%), as potential material candidates for tokamak components facing the fusion plasma, have been assessed at a temperature of ∼400 °C, by exposing the material surface to 40 eV He for increasing He fluences up to 1027 m−2 and flux of ∼1023 m−2 s−1. Surface wave-like structures appear in all samples at a fluence of ∼1026 m−2, whereas at the higher fluence of ∼1027 m−2 the material's surface is characterised by the presence of blisters and ablations. This suggests a new critical fluence for blistering in pure He plasma to be between 1026 and 1027 m−2. There is also a near-surface layer with a thickness of ∼200 nm that contains He bubbles of 2.20–2.70 nm in average size. Increasing Ta content leads to a small reduction in bubble size, and to clear reductions in the presence of blisters and ablations. Ta alloying can improve the hardness and yield strength and reduce the He diffusivity in the material. This therefore delays bubble formation and surface blistering and ablations that are affected by these mechanical properties. This was exemplified at the highest fluence by a large mitigation of surface material ablation.

Oral ulcer and skin lesions: a tell-tale sign of pemphigus vulgaris

Aim: The aim of this case presentation was to highlight the importance of the awareness of two different coexisting pathologies, as well as emphasise that early diagnosis and prompt management are essential to manage pemphigus vulgaris. Pemphigus vulgaris is a rare, life-threatening autoimmune disease characterised by the presence of blisters on the surface of oral mucosa caused by antibodies against adhesion molecules on the cell surface of keratinocytes. Coexistence with various conditions, notably herpes simplex virus, is noteworthy. Case report: We report a case of a middle-aged female who presented with non-healing oral ulceration that turned out to be herpes simplex virus, consequently triggering pemphigus vulgaris. Histopathology and immunofluorescence were suggestive of pemphigus vulgaris, but immunohistochemistry and polymerase chain reaction were indicative of herpes simplex virus infection. Conclusion: The coexistence of a viral infection with pemphigus vulgaris poses a therapeutic challenge.

Environmental factors in autoimmune bullous diseases with a focus on seasonality: new insights.

Autoimmune bullous diseases are a heterogeneous group of rare conditions clinically characterized by the presence of blisters and/or erosions on the skin and the mucous membranes. Practically, they can be divided into two large groups: the pemphigoid group and the pemphigus group, depending on the depth of the autoimmune process on the skin. A family history of autoimmune diseases can often be found, demonstrating that genetic predisposition is crucial for their development. Moreover, numerous environmental risk factors, such as solar radiation, drugs, and infections, are known. This study aimed to evaluate how seasonality can affect the trend of bullous pemphigoid and pemphigus vulgaris, especially considering the number of hospitalizations recorded over the course of individual months. The total number of hospitalizations in the twelve months of the year was evaluated. Moreover, blood chemistry assay and, for some patients, enzyme-linked immunosorbent assay were executed to evaluate antibodies. Regarding the severity of the disease, the bullous pemphigoid area index and the pemphigus disease area index score systems were used. Results showed a complex interplay between environmental factors such as seasons and autoimmune conditions.

Effects of photobiomodulation (660 nm laser) on anthracycline extravasation: An experimental study.

Objective: to investigate the effect of using different agents (topical hyaluronidase, photobiomodulation, and the association of photobiomodulation with topical hyaluronidase) in preventing the formation of lesions caused by doxorubicin extravasation, as well as in the reduction of lesions formed by extravasation of this drug. Method: a quasi-experimental study conducted with 60 Wistar rats, randomized into four groups with 15 animals each. Group 1 (Control); Group 2 (Hyaluronidase); Group 3 (Photobiomodulation); and Group 4 (Hyaluronidase + Photobiomodulation). A wound was induced by applying 1 mg of doxorubicin to the subcutaneous tissue of the back of the animals. The concentration of topical hyaluronidase was 65 turbidity units/g and the energy employed was 1 joule of 100 mW red laser per square centimeter. With macroscopic evaluation every two days for 28 days, the following variables were observed: skin integrity, presence of blisters, hyperemia, exudate, bleeding, edema, crust, peeling and granulation tissue. Results: the animals from the groups subjected to photobiomodulation obtained better results in the assessment of the following variables: bleeding, hyperemia, exudate, intact skin and edema. Conclusion: it was evidenced that the association of photobiomodulation with topical hyaluronidase was effective in reducing the local effects and assisted in the wound healing process, and that PBM alone was able to prevent appearance of lesions.

The blister occurring in severe tibial plateau fractures (Schatzker V-VI) decreases the risk of acute compartment syndrome.

Severe tibial plateau fractures may result in acute compartment syndrome (ACS) of the leg, which is always considered to be an orthopaedic emergency. Blistering is not an uncommon sign and may be related to decreased compartment pressure. No experiments on the risk of ACS based on the presence of blisters after tibial plateau fractures have been conducted, and controversies about the high rate of ACS in patients with tibial plateau fractures still exist. This research retrospectively followed the bicondylar tibial plateau fractures treated with locking plates and verified if the risk of ACS was decreased after a blister was observed. A total of 100 patients with closed tibial fractures (63 men and 37 women) were included and divided into with blister (group A, 40) and without blister groups (group B, 60). The creatine kinase (CK), BUN, and chloride levels were recorded on the first day after hospitalization. The hospitalization costs and injury to operation time were collected in the two groups. The Lysholm knee score and a visual analogue scale (VAS) for pain were used to assess the rehabilitation after follow-up. Clinical and serological results of ACS in the two groups were compared. There was significant delay in the time from injury to operation (11.0 ± 3.5 VS 7.6 ± 7.2, Z = - 3.771, P < 0.001) in the with blister (group A) and without blister groups (group B). The levels of chloride and BUN were significantly lower in the with blister group than in the without blister group (102.7 ± 3.0 VS 104.7 ± 2.57 mg/dL, Z = - 3.33, P = 0.001) (10.3 ± 2.5 VS 10.3 ± 2.8 mg/dL, Z = - 2.366, P = 0.018). There were no significant differences in the CK levels in the with blister and without blister groups (285.8 ± 202.6 VS 408.4 ± 633.6 U/L, Z = - 1.379, P = 0.168), but a trend of decreasing to normal was obvious in patients with blisters. There were no significant differences in the Lysholm knee score (40 VS 60, 80 ± 4.9 VS 79.8 ± 3.0, Z = - 0.872, P = 0.383), or the VAS (40 VS 60, 1.6 ± 0.7 VS 2.2 ± 1.3, Z = - 1.568, P = 0.117) for pain compared with patients without blisters. In conclusion, the presence of blisters in patients with severe tibial plateau fractures decreases the pressure in the compartment. There was a significant improvement in serological results after blisters appeared, which may be related to the reason for the decreased pressure decreased, and conservative management is recommended for these patients.

ANALYSIS OF LIQUID MEDIATED CONTACT OF GLASS COLLOIDAL PARTICLE WITH POLYSTYRENE COATED SURFACE

Spin coating has been widely used for obtaining uniform thin polymeric coating over glass surfaces. Previous studies have shown that the thin-coated film can deform and bulge out upon immersion in liquid. Such deformations can affect various properties of the films. In this study, we have analyzed the interaction of glass colloidal particle and the polystyrene (PS) spin-coated surface immersed in deionized (DI) water. It was found that the glass colloidal particle interacts with the surface in dissimilar way at various locations on the surface. A sudden reduction in the forces was also observed at different locations on the same surface. The separation distances at which the sudden change in the force occurred was closer to the height of the spherical domains. Therefore, the change could be attributed to the presence of blisters on the surface formed due to permeation of water into the thin film-substrate interface.

Peroxiredoxin II (PRDX2) Is a Novel Candidate Gene for Congenital Dyserythropoietic Anemia

CDAR (ClinicalTrials.gov Identifier: NCT02964494), a registry for patients with Congenital Dyserythropoietic Anemia (CDA) in North America, has been created with the goal to provide a longitudinal database and associated biorepository to facilitate natural history studies and research on the molecular pathways involved in the pathogenesis of CDAs. A 1 y.o. female patient with non-immune hemolytic anemia with suboptimal reticulocytosis, requiring frequent transfusions, and with the pathologic diagnosis of CDA was enrolled in CDAR. Her father had a similar phenotypical presentation in early childhood and underwent splenectomy at 3 years of age. Since then, he has rarely required transfusions but he continues to have a mild anemia at baseline with characteristics of hemolysis and with suboptimal reticulocytosis; at the time of enrollment, he had hemoglobin of 9.3 g/dL with absolute reticulocyte count of 115 x 106 cells/µl. Next Generation sequencing and deletion/duplication assay for the known CDA-associated genes (CDAN1, C15ORF41, SEC23B, KIF23, GATA1) identified no mutations. Whole-exome sequencing for the patient and her parents (family-trio design) revealed a novel PRDX2 missense variant (c.154C>T; p.Pro52Ser) present in heterozygous state in both proband and her father; no mutation in this gene was present in the asymptomatic mother. In silico prediction programs suggest that this variant is probably damaging and deleterious, causing a non-conservative substitution of a phylogenetically highly-conserved amino acid (down to Baker's yeast), and located in an enzymatically active protein domain, adjacent to the active Cys51, with the potential to change its conformation.Peroxiredoxin II is highly expressed during terminal erythropoiesis and is one of the most abundant proteins after hemoglobin in erythroblasts and mature erythrocytes. It is an antioxidant enzyme that reduces the reactive oxygen species (ROS), like hydrogen peroxide and alkyl hydroperoxides readily produced within the erythroid cells due to the presence of heme iron and oxygen. In addition, PRDX2 has been implicated in intracellular signaling, cellular proliferation and differentiation, and as a regulator of iron homeostasis. PRDX2-/- mice were found to have hemolytic anemia with evidence of oxidative damage of the erythrocyte proteins resulting to decreased red blood cell (RBC) survival. The aim of this work is to validate the pathogenetic role of the PRDX2 variant found in this family as the molecular cause of this dominantly-inherited CDA and further investigate the role of PRDX2 in human terminal erythropoiesis.Central review of the patient's bone marrow aspirate and biopsy slides, according to the CDAR protocol, revealed erythroid hyperplasia with dyserythropoiesis, including megaloblastoid changes, nuclear lobation and fragmentation, and binucleated erythroblasts (less than 10%), compatible with atypical CDA. There were rare erythroids with cytoplasmic bridging but no nuclear bridges. Review of the peripheral blood smear showed significant poikilocytosis, mild polychromasia, and the presence of blister and ghost cells reminiscent of G6PD deficiency, pointing to RBC damage by oxidative stress. Induced pluripotent stem cells (iPSCs) and EBV-immortalized lymphocytes were generated from the patients' peripheral blood mononuclear cells after informed consent per CDAR protocol, to allow further in vitro studies of the peroxiredoxin II-deficiency. Flow cytometry confirmed significantly increased ROS in the patients' derived versus control EBV-immortalized lymphocytes as well as in the reticulocytes and mature erythrocytes of the proband and her father, indicating that their PRDX2 variant is causing loss-of-function of the enzyme and increased oxidative stress.Further work is ongoing to explore the mechanisms of pathogenicity of peroxiredoxin II deficiency towards human dyserythropoiesis and decreased erythrocyte lifespan. To our knowledge, this is the first case of anemia described in humans associated with PRDX2 mutation implicating this gene as a novel candidate gene for atypical, dominantly-inherited CDA. DisclosuresNo relevant conflicts of interest to declare.

Influence of near-surface blisters on deuterium transport in tungsten

The effect of near-surface blisters on deuterium transport in tungsten is studied by means of nuclear reaction analysis (NRA) and scanning electron microscopy (SEM). Gentle deuterium plasma loading of different durations and subsequent NRA depth profiling is performed in heavily pre-blistered and unblistered areas on self-damaged tungsten samples. Comparison of the deuterium depth profiles reveals a considerable reduction of the deuterium transport into the bulk due to the presence of near-surface blisters. SEM and NRA results identify the enhanced re-emission of deuterium from the sample due to open blisters as the underlying mechanism, which reduces the deuterium flux into the bulk. Based on a simple analytical hydrogen retention model, the re-emitted deuterium flux by open blisters is determined to be 80% of the implanted deuterium flux in the present conducted experiment. In addition, the deuterium flux into the bulk is reduced by 60% compared to the unblistered case. Hence the presence of blisters is not a general disadvantage in the context of retention, but can be beneficial in slowing down the build up of a certain hydrogen inventory and in reducing the permeation flux.

Study about the Effectiveness of Serial Stretching in Post Burn Elbow and Knee Flexion Contracture

Study about the Effectiveness of Serial Stretching in Post Burn Elbow and Knee Flexion Contracture

Skin manifestations in sulfur mustard exposed victims with ophthalmologic complications: Association between early and late phase.

ContextSulfur mustard (SM) was used during the Iraq-Iran war (1980–1988). Exposed veterans continue to suffer from its ocular, skin, and respiratory complications.ObjectiveWe aimed to evaluate associations between early (at the time of acute exposure) and decades later skin manifestations in individuals with severe ophthalmologic complications secondary to sulfur mustard exposure.Materials and methodsOne hundred forty-nine veterans with severe ocular injuries were evaluated for acute and chronic skin complications. Logistic regression models were used to examine the associations between early and late skin manifestations.ResultsLate skin complaints were observed in nearly all survivors who had early skin lesions (131 out of 137; 95.62%). Seven out of 12 patients (58.33%) who did not have early skin lesions ultimately developed late skin complications. There was a significant relationship between the presence of lesions at the time of exposure and developing late skin complaints (two-sided Fisher's exact test, OR = 15.59, p < 0.001). There was an association between having at least one early skin lesion and occurrence of late skin complications. Survivors with blisters at the time of chemical exposure were more likely to complain of itching (95% CI: 3.63–25.97, p < 0.001), burning (OR = 11.16; 95% CI: 2.97–41.89, p < 0.001), pigmentation changes (OR = 10.17; 95% CI: 2.54–40.75, p = 0.001), dryness (OR = 6.71, 95% CI: 1.22–37.01, p = 0.03) or cherry angioma (OR = 2.59; 95% CI:1.21–5.55, p = 0.01) during the late phase. Using multivariate logistic models, early blisters remained significantly associated with latent skin complaints. Of note, the genitalia and great flexure areas were the most involved anatomical sites for both early and late skin lesions in SM exposed survivors.ConclusionAccording to this study, the presence of blisters at the time of exposure to SM is the most important predictor of developing dermatologic complications decades later in patients with severe ophthalmologic complications from sulfur mustard exposure.

Bullous myringitis: A cause of hearing loss

Bullous myringitis is defined by the presence of blisters on the tympanic membrane which has generally a severe otalgia as a first symptom of presentation. This clinical picture sometimes may be accompanied by sensori-neural hearing loss. In this study, we aimed to share visual content of a patient with Bullous myringitis admitted to the emergency department. A 24-year-old male patient complained of a right severe pain in the right ear and hearing loss was admitted to the emergency department. On physical examination the right tympanic membrane was oedematous, hyperaemic and blisters were seen. The patient was referred to ENT department for evaluation of hearing loss. Bullous myringitis with sensori-neural hearing loss in the right ear was diagnosed. For treatment, pain control and warm compression was recommended. Antibiotic therapy has been also planned for middle ear infection. ENT follow-up were planned for the assessment of hearing loss. Many microorganisms, especially viruses, m.pneumoniae, chlamydia may cause Bullous myringitis. In the literature bullous myringitis cases that admitted to ED with sensori-neural hearing loss have been reported. Diagnosis is made by clinical examination. Pain control and mild compression may be sufficient for treatment. If concomitant otitis media is present, antibiotics should be added to treatment.

Self-sealing shells: blowouts and blisters on the surfaces of leaky wind-blown bubbles and supernova remnants

Blowouts can occur when a dense shell confining hot, high pressure, gas ruptures. The venting gas inflates a blister on the surface of the shell. Here we examine the growth of such blisters on the surfaces of wind-blown-bubbles (WBBs) and supernova remnants (SNRs) due to shell rupture caused by the Vishniac instability. On WBBs the maximum relative size of the blister (R_bstall/R) is found to grow linearly with time, but in many cases the blister radius will not exceed 20 per cent of the bubble radius. Thus blowouts initiated by the Vishniac instability are unlikely to have a major effect on the global dynamics and properties of the bubble. The relative size of blisters on SNRs is even smaller than on WBBs, with blisters only growing to a radius comparable to the thickness of the cold shell of SNRs. The small size of the SNR blowouts is, however, in good agreement with observations of blisters in the Vela SNR. The difference in relative size between WBB and SNR blisters is due to the much higher speed at which gas vents out of WBBs, which translates into a greater energy flux through a rupture of a given size from interior gas of a given pressure. Larger blisters are possible if shell ruptures are bigger than expected. We expect the observed velocity structure of SNR shells to be affected by the presence of blisters until the shell is no longer susceptible to ruptures, since the initial expansion of blisters is faster than the ongoing expansion of the shell.

Immunofluorescence antigen mapping for hereditary epidermolysis bullosa

Epidermolysis bullosa (EB) is a group of inherited, mechanobullous disorders that are caused by mutations in the structural proteins in the epidermis or dermoepidermal junction. Characteristic clinical picture is the presence of blisters at trauma prone areas of the body, which develops at or soon after birth. Availability of specific monoclonal antibodies against the target proteins together with advances in the molecular genetics have led to the revision in the classification of EB. Now four major types of EB are recognized depending upon the level of blister and the location of target protein: EB simplex (epidermolytic), junctional EB (lucidolytic), dystrophic EB (dermolytic) and Kindler's syndrome (mixed cleavage plane). The laboratory tests not only help to confirm the diagnosis of EB but are also an important tool to classify (and subtype) EB. These include immunofluorescence antigen mapping (IFM), transmission electron microscopy (TEM) and mutation analysis. IFM is the most preferred method for final diagnosis of EB worldwide. It is relatively easy to perform and results can be obtained rapidly. This article describes the technicalities and significance of IFM in various types of EB.

Monitorization of drug content in furosemide and lorazepam tablets stored in multidose pill boxes

Background:Therapeutic nonadherence is a major health problem, particularly when therapeutic regimens are complex and long-lasting. Therefore, tools such as multidose pill boxes have been designed to provide the means for higher therapeutic compliance. However, no studies are available reporting on their capacity to keep the drug content of the stored tablets unaltered.Objective:This work aimed at monitoring the drug content of tablets stored in multidose boxes for a period of two weeks.Materials and Methods:Furosemide and lorazepam were selected as model drugs, given their frequent chronic use, which is coherent with the profile of medicines susceptible of storage in the referred boxes. Variations of the tablets drug content were assessed as a function of temperature (25°C and 40°C) and the presence of blister.Results and Discussion:The obtained results allowed concluding that concerning temperature, only lorazepam tablets registered drug content alterations and only when stored at 40°C. On the other side, it was concluded that the absence of blister does not compromise the drug content of the studied tablets.ConclusionIn the specific conditions of this study, the storage of these medicines in multidose boxes is considered reliable and adequate.

Pemphigoid gestationis: early onset and blister formation are associated with adverse pregnancy outcomes

It is unclear whether clinical features of pemphigoid gestationis (PG), such as timing of onset and severity, may affect pregnancy outcomes or whether the adverse outcomes in pregnancies complicated by PG are related to or worsened by systemic corticosteroid treatment. To evaluate the associations of adverse pregnancy outcomes with clinical features, autoantibody titre of PG, and systemic corticosteroid treatment. We conducted a retrospective cohort study recruiting 61 pregnancies complicated by PG from the St John's Institute of Dermatology database which enrolled cases from dermatologists across the U.K., and two tertiary hospitals in the U.K. and Taiwan. Outcome measures included gestational age at delivery, preterm birth, birthweight, low birthweight (LBW, i.e. birthweight < 2500 g), small-for-gestational-age (i.e. birthweight below the 10th percentile for gestational age), fetal loss, congenital malformation, and mode of delivery. After controlling for maternal age and comorbidity, decreased gestational age at delivery was significantly associated with presence of blisters (P = 0.017) and disease onset in the second trimester (P = 0.001). Reduced birthweight was significantly associated with disease onset in the first and second trimesters (P = 0.030 and 0.018, respectively) as was also LBW [adjusted odds ratio (95% confidence interval) 13.71 (1.22-154.59) and 10.76 (1.05-110.65), respectively]. No significant associations of adverse pregnancy outcomes with autoantibody titre or systemic corticosteroid treatment were found. Onset of PG in the first or second trimester and presence of blisters may lead to adverse pregnancy outcomes including decreased gestational age at delivery, preterm birth, and LBW children. Such pregnancies should be considered high risk and appropriate obstetric care should be provided. Systemic corticosteroid treatment, in contrast, does not substantially affect pregnancy outcomes, and its use for PG in pregnant women is justified.

Rheumatoid Arthritis Associated With Pemphigus Foliaceus in a Patient Not Taking Penicillamine

A 50‐year‐old‐woman presented with a history of crusted plaques on her face and trunk. On physical examination, she had a disseminated dermatosis involving the face, chest, trunk, abdomen, and both ankles. She had erythematous and scaly plaques on both cheeks (Figure 1). In both ears and on the rest of the body, she presented with scarce intact vesicles and blisters, a few eroded and crusted vesicles, and residual hyperpigmented macules. The onset of the dermatosis occurred 6 months before diagnosis, affecting the chest, followed by further spreading of vesicles on the body. She denied ever having developed ulcerative or erosive lesions on mucosal surfaces. The presence of blisters were followed by the development of crusts and hyperpigmented macules. One month before visiting our service, the patient had been receiving treatment with dapsone, with slight improvement of the cutaneous lesions. Biopsy results of one of the scaly plaques on the cheeks demonstrated a subcorneal blister with a few acantholytic cells and a scarce inflammatory infiltrate in the papillary dermis (Figure 2). Because of the clinical picture, especially the erythematous lesions on both cheeks, tests for antinuclear antibodies were performed to rule out pemphigus erythematosus, and the results were negative. Besides the cutaneous manifestations, the patient had had signs and symptoms of arthritis for at least 11 years; she had received sporadic relief with the nonsteroidal anti‐inflammatory drug ketoprofen. She reported generalized morning rigidity lasting for 2 hours and arthralgias in the temporomandibular joints, elbows, wrists, metacarpophalangeal joints, knees, and ankles. On examination, she had phlogosis and synovial thickening in the elbows, wrists, metacarpophalangeal joints, knees, and ankles. She also had flexion contractures on both elbows as well as ulnar deviation of the left hand and swan‐neck deformity in several fingers. Radiographic examination of the hands demonstrated generalized osteopenia, decreased articular spaces in metacarpophalangeal and proximal interphalangeal joints, and slight erosion in the carpal bones (Figure 3). Results of rheumatoid factor testing were positive (521 IU/mL). The diagnoses of both pemphigus foliaceus and rheumatoid arthritis were made. We performed high‐resolution DNA typing of HLA‐DRB1 polymorphism using sequence‐specific oligonucleotides,1 and found that the patient carried HLA DRB1*0404 and *1406. The patient had erythematous and scaly plaques on both cheeks. image Biopsy revealed a subcorneal blister with a few acantholytic cells and a scarce inflammatory infiltrate in the papillary dermis. image Radiography of the hands, revealed generalized osteopenia, decreased articular spaces in metacarpophalangeal and proximal interphalangeal joints, and slight erosion in the carpal bones. image

Plasmapheresis therapy in pemphigus vulgaris and bullous pemphigoid

Blistering dermatitises are characterized by the presence of blisters that begin owing to acantholysis (intraepidermic blister) such as pemphigus vulgaris (PV) or owing to dermoepidermic detachment (subepidermic blister) such as bullous pemphigoid (BP). Both diseases are autoimmune pathologies characterized by the presence of autoantibodies against specific adhesion molecules of the skin and mucous membranes. PV, in which oral lesions are always present, has a progressive course that, if the disease is not treated, nearly always brings to death from sepsis within a few years. In BP, oral lesions are rare and the disease, that is most frequent in older individuals, has a chronic course with spontaneous remissions. Systemic corticosteroids and immunosuppressants are the mainstay of treatment of these two diseases. Although this therapy had reduced the mortality of the two pathologies it is associated with serious side effects. To reduce the corticosteroids dose and to improve the symptomatology in resistant therapy cases, we treated five patients with several procedures of plasma exchange. Four patients were affected by BP and one by PV. Their disease severity at onset of plasmapheresis ranged from mild to severe. One of 5 patients suffered a plasmapheresis side effect. All patients responded with complete remission of symptomatology and had a prednisone dosage reduction until 70%. Plasmapheresis is an effective treatment for PV and BP patients who have been unresponsive to conventional therapy, for those for whom conventional drugs are contraindicated, for those who show severe clinical manifestations and for those who need high doses of corticosteroids and immunosuppressants to keep the disease under control.

NEW IMMUNOMODULATING DRUGS IN AUTOIMMUNE BLISTERING DISEASES

The autoimmune blistering diseases are a fascinating group of diseases characterized by the presence of blisters involving the skin and mucous membranes. Understanding of the diagnosis, pathophysiology, and advances in treatment of these diseases has grown enormously in recent years. In this article, the author discusses the major clinical and immunopathologic findings in bullous pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, linea IgA bullous disease, and pemphigus. The article focuses on the therapeutic management of patients with autoimmune blistering diseases, including the appropriate treatment of patients, with particular emphasis on the use of immunomodulating and immunosuppresive agents.

A one hospital study of the effect of wound dressings and other related factors on skin blistering following total hip and knee arthroplasty

Skin blisters occur when the epidermis is separated from the dermis. This occurs as a result of continued friction. Blisters occurring lateral to the surgical incision of patients following orthopaedic surgery have been observed for many years. There is, however, a lack of empirical evidence indicating the causation of wound blistering. The aim of the study was to identify the prevalence of wound blistering within a specialist orthopaedic hospital, and in addition to determine the cause(s). A quasi-experimental design was used to investigate the prevalence and causation of wound blistering with a convenience sample of 169 patients following primary total hip and knee replacement. Data were collected at four time intervals to assess if wound blistering had occurred between surgery and 72 h post-operatively. The data were recorded on a specially designed form, completed by a registered nurse at the four interval points. Data were collected on type of dressing used, presence of blisters around the wound site with initial data collected on known allergies, use of steroids and type of skin preparation used during the procedure. The data were then analysed using Chi-square test to ascertain if significant statistical differences existed between formation of blisters and a number of independent variables including: type of wound dressing, type of surgical skin preparation used, use of steroids and patients having known allergies. From the sample (n=169), 22 patients (13%) developed blistering. No statistically significant difference was found between any of the independent variables (P value 0.05). It is, however, noteworthy that only 8 of the patients with ‘Opsite Post Op’ (n=88) developed blisters compared to 4 of the 28 patients who had a ‘Mepore’ dressing. This would appear to affirm earlier findings that stated that lack of elasticity of dressings coupled with postoperative wound oedema is a contributing factor to formation of wound blistering. In addition, the nursing staff reported that they found Opsite Post Op dressing easy to apply and remove compared to other types of dressings available.