Development of a bullous pemphigoid after split-skin grafting

Ghura, Harvinder S.; Johnston, Graham A.R.; Milligan, A.

doi:10.1054/bjps.2001.3601

Cited by 15 publications

(20 citation statements)

References 3 publications

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“…BP is an autoimmune blistering condition seen most commonly in elderly patients with subepidermal blisters seen on histology and linear deposits of IgG and C3 complement along the basement membrane. A few cases of localized BP arising at sites of trauma, in particular surgical scars, have been reported following hemiarthroplasty, abdominal aortic aneurysm repair, hernia repair, skin grafting, and hemodialysis venous access procedures . Authors have proposed a “koebnerizing” process triggering blister formation but not all patients had pre‐existing pemphigoid.…”

Section: Discussionmentioning

confidence: 99%

Bullous Pemphigoid Arising in Lower Leg Vein Graft Incision Site

2015

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Section: Discussionmentioning

confidence: 99%

Bullous Pemphigoid Arising in Lower Leg Vein Graft Incision Site

2015

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“…It is hypothesized that local injury unmasks BP antigens, increasing the likelihood of an autoimmune attack. 9 Another hypothesis suggests that during the healing process, BP antigens become more available for binding, leading to attack. 9 This hypothesis may explain the several-week delay often observed 9 -11 between injury and blister appearance, because the healing process is fairly lengthy.…”

Section: Discussionmentioning

confidence: 99%

“…9 Another hypothesis suggests that during the healing process, BP antigens become more available for binding, leading to attack. 9 This hypothesis may explain the several-week delay often observed 9 -11 between injury and blister appearance, because the healing process is fairly lengthy. These theories also suggest a rationale for the presence of both local and distant bullae.…”

Section: Discussionmentioning

confidence: 99%

Bullous Lesions on a Skin Graft Donor Site

Orvis

Ihnatsenka²,

Hatch³

2009

The Journal of the American Board of Family Medicine

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Patients with bullous lesions often present to family physicians. In many cases, the diagnosis is readily apparent based on a focused history and examination. We report a case in which the correct diagnosis, bullous pemphigoid (BP), was obscured by an unusual presentation. Although some lesions were typical of BP, most were clustered on a recent skin graft donor site and some were hemorrhagic. A review of recent family medicine literature revealed one article discussing BP, 1 but neither this article nor 3 dermatology textbooks 2-4 mentioned this presentation. However, further literature review revealed that this presentation is actually well described and fits nicely with current understanding of the etiology of BP. The review also revealed an important recent change in BP management: the emergence of ultra-high-potency topical steroids as a first line therapy. As recently as 6 years ago, oral steroids were the standard approach for treating most BP patients. The following case provides an opportunity to review recent advances in the understanding and management of BP, a condition most family physicians can expect to encounter. 3The discussion also addresses the differential diagnosis of bullous lesions and the need for special punch biopsy specimen media if BP is suspected. Case ReportsA 53-year-old woman presented with painless blisters of several days' duration. One month before she sustained a third-degree burn of the right foot requiring a split-thickness skin graft. Her blisters were disproportionately concentrated on the skin graft donor site (Figure 1) but were also present on the left shin (Figure 2). She denied fever and itching and complained only of chronic foot pain ever since skin graft surgery. She denied applying any topical products to the donor site or her legs and denied any recent change in skin care products. The patient had never experienced a similar blistering episode.Her recent medical history included a hospital admission 2 weeks earlier for aspiration pneumonia. Recovery was uneventful apart from Clostridium difficile colitis caused by piperacillin/tazobactam, which was successfully treated with metronidazole. Medical history included insulin-dependent diabetes, chronic renal insufficiency, coronary artery disease, hypertension, and cerebrovascular accident with mild residual right-sided weakness. Medications included oxycodone/acetaminoiphen; lansoprazole; aspirin; atorvastatin; clopidogrel; metoprolol; venlafaxine; albuterol; gabapentin; insulin; Culturelle (an OTC pro-biotic; Amerifit Brands, Inc., Cromwell, CT); and metronidazole.Vital signs were normal during physical examination. The skin graft donor site contained multiple tense bullae with hemorrhagic contents (Figure 1). Similar bullae with clear fluid were seen on the left anterior shin (Figure 2). The bullae were oval to round in shape, 1.5 to 4 cm in diameter, tense, and painless to the touch. There were no lesions in the oral cavity. Gentle pressure applied to the blisters did not cause them to spread outwards, thus yiel...

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“…Furthermore the alteration of the skin integrity could promote a rapid blister formation [4]. Also local changes due to the wound healing process may facilitate presentation of the BP antigens [3] perhaps explaining why blistering often occurs some weeks after grafting [2].…”

Section: Clinical Lettersmentioning

confidence: 99%

Bullous pemphigoid appearing both on thermal burn scars and split‐thickness skin graft donor sites

Neri

Antonucci

Balestri

et al. 2013

J Deutsche Derma Gesell

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Dear Editors,Bullous pemphigoid (BP) is a common subepidermal autoimmune bullous disease. A number of external agents have been associated with its development, including trauma, thermal burns, skin grafts, radiotherapy, ultraviolet exposure (UVB, PUVA), photodynamic therapy, surgery, vaccination and cutaneous infections. An 85-year-old woman presented with a two-month history of blistering lesions on the back, legs and abdomen ( Figure 1). She complained generalized itch and had widespread erosions and crusts on erythematous skin. Remarkably, all the lesions appeared on thermal burn scars (some of which had been covered with meshed split-thickness autografts 20 months before) and on donor sites. Her medical history included hypertension and atrial fibrillation and she had been treated with a calcium channel blocker and warfarin for several years. Skin biopsies from both scar area and donor site revealed a subepidermal detachment and superficial dermal infiltrate consisting of lymphocytes and eosinophils. Direct immunofluorescence showed linear deposits of IgG and C3 at the basement membrane and BP180 ELISA was positive, confirming the diagnosis of localized BP.

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Development of a bullous pemphigoid after split-skin grafting

Cited by 15 publications

References 3 publications

Bullous Pemphigoid Arising in Lower Leg Vein Graft Incision Site

Bullous Pemphigoid Arising in Lower Leg Vein Graft Incision Site

Bullous Lesions on a Skin Graft Donor Site

Bullous pemphigoid appearing both on thermal burn scars and split‐thickness skin graft donor sites

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