Blisters

About: Blisters is a research topic. Over the lifetime, 980 publications have been published within this topic receiving 16229 citations.

Prurigo pigmentosa clinically and immunologically mimicking autoimmune bullous disease: A case report

Abstract: A 15-year-old Japanese male noticed brown macules on his back 9 months ago. Initial examination revealed reticulated infiltrative erythema and pigmentation with blisters on the erythema of the back. Histopathology showed blisters with eosinophil infiltration in the epidermis, and direct immunofluorescence showed negative results for immunoglobulin (Ig) G, Ig A, Ig M, and C3 in the epidermal basement membrane zone. Immuno-serological tests revealed the presence of IgG antibodies against BP180, linear IgA disease antigen 1 (LAD-1), and laminin α3. The autoimmune bullous disease was suspected, and prednisolone at a concentration of 20 mg/day (0.3 mg/kg/day) was started. When the prednisolone dose was reduced to 10 mg/day, erythema and blisters recurred. The patient was diagnosed with prurigo pigmentosa based on clinical features and was treated successfully with oral doxycycline hydrochloride hydrate and topical tacrolimus ointment. This is the first case of prurigo pigmentosa with blisters in which autoantibodies to the epidermal basement membrane zone were found, which might be secondary non-pathogenic antibodies.

Cutaneous toxicity with suprabasal blisters and dyskeratosis following administration of enfortumab vedotin

Abstract: Dear Editor, Enfortumab vedotin (EV) is an antibodydrug conjugate composed of an antibody specific for nectin4, which is highly expressed in urothelial carcinoma (UC), and the microtubule disruptor monomethyl auristatin E. EV is approved for metastatic UC that has progressed on existing chemotherapy but is associated with a high rate of skin eruptions (48%).1 A case of vesiculobullous eruption following administration of EV is described. A 78yearold man with stage IV bladder cancer that had been recalcitrant to gemcitabine, cisplatin, paclitaxel, and avelumab was started on EV (1.25 mg/kg) on days 1, 8, and 15 of a 28day cycle. Five days after cycle 3, day 8 infusion, the patient presented with a pruritic rash on the extremities. Physical examination showed fever (38.2°C) and confluent dusky erythema on the extremities accompanied by grouped tense vesicles and bullae on the left leg (Figure 1a,b; Figure S1a), whereas erythema on the trunk was sparse (Figure S1b,c). Laboratory examination showed a white blood cell count of 4180 cells/μL, 0.2% eosinophils, and serum Creactive protein of 2.91 mg/ dL. The patient's general condition was otherwise stable without liver dysfunction and mucosal involvement. Histological findings of a skin biopsy taken from the left thigh showed suprabasal blisters, spongiosis, and marked dyskeratosis mainly in the suprabasal layers of the epidermis (Figure 1c,d). Results of direct and indirect immunofluorescence studies were negative. Serum antidesmoglein (Dsg) 1, antiDsg 3, and antibullous pemphigoid 180NC16A antibodies, evaluated by chemiluminescent enzyme assay, were not detected. EV was discontinued, and the patient was treated with oral prednisolone 30 mg/day (0.5 mg/kg/day). Within 1 week, there was a significant improvement of the skin lesions. Prednisolone was tapered off over 3 weeks without any signs of recurrence. The Naranjo scale resulted in a scale of 6, indicating a probable association between EV and the bullous skin eruption in this case. Compared with classical clinical presentations of StevensJohnson syndrome (SJS), which was characterized by flaccid and easily ruptured blisters and mucous involvement, this case presented with a tense vesiculobullous eruption on the left leg that was devoid of mucous lesions. Because of the lack of typical findings of SJS, we treated the patient with mediumdose PSL. Data mining of the US Food and Drug Administration adverse event reporting system showed three fatal cases of SJS due to EV.1 EV was not readministered concerning the possible development of SJS following the next administration. This case showed dyskeratosis mainly observed in the suprabasal area and similar cases have been reported.2,3 In addition, suprabasal dyskeratosis in clinically intact skin have also been reported in a case with EVrelated rash displaying milialike eruptions.2 Recently, Penny et al.4 reported two cases of EVrelated rash demonstrating keratinocyte cell surface deposition of IgG and C3 concentrated in the upper half of the epidermis. Although it was not concluded that the detected antibodies were EV, these results are interesting because nectin4 is expressed in the suprabasal layers of the normal epidermis.5 Because EV is lastline oncological therapy, it is important to accumulate case reports to establish appropriate management of EVrelated rash.

Annular bullous pemphigoid: A case report and review of literature

Abstract: Bullous pemphigoid is an autoimmune blistering disease that primarily affects the geriatric population. It often presents as urticarial erythematous plaques, which evolve into subepidermal blisters accompanied by pruritus. Although rare, clinical variants of bullous pemphigoid have been documented. We present a rare case of annular bullous pemphigoid in a 50-year-old male and offer a brief review of the literature. Only five other case reports, including three in adults, have described this unusual presentation, which can mimic other autoimmune blistering diseases, including linear IgA bullous dermatosis and pemphigus herpetiformis. Therefore, histopathology and immunologic studies were essential in properly diagnosing this patient. Our case supports that annular blistering lesions can be a clinical variant of bullous pemphigoid.

Reduction of surface erosion caused by helium blistering: comparison between vacuum-cast and sintered-beryllium

Abstract: The blister formation and the erosion associated with blistering in a vacuum cast beryllium foil and in a foil of sintered beryllium powder have been investigated for irradiation at room temperature and at 600$sup 0$C with 100 keV $sup 4$He$sup +$ ions for total doses of 0.5 to 1.0 C cm$sup -2$. For room temperature irradiation the blisters in sintered beryllium powder are smaller in size than in vacuum cast beryllium. For irradiation at 600$sup 0$C large scale exfoliation of blisters was observed for vacuum cast beryllium but only small amount of exfoliation was seen for sintered beryllium powder. The results show a reduction in erosion rate in sintered beryllium as compared to the erosion rate in vacuum cast beryllium. For room temperature irradiation no erosion rate could be determined for the sintered beryllium foil since no blister exfoliation was observed. For 600$sup 0$C irradiation the erosion rate for sintered beryllium foil is more than an order of magnitude smaller than for vacuum cast beryllium. (auth)