Occurrence of Bullous Lesions in Acute Barbiturate Intoxication

Beveridge, G. W.; Lawson, A. A. H.

doi:10.1136/bmj.1.5438.824

Cited by 59 publications

(29 citation statements)

References 4 publications

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“…Since then, most previously reported cases with characteristic bullous skin lesions and sweat gland necrosis were comatose secondary to an overdosage of drugs (3)(4)(5)9), carbon monoxide poisoning (10), alcohol toxicity (11), or central nervous system disorders (12) such as hypoglycemia (13) or diabetic ketoacidosis (14). Similar clinical and histopathologic features can also be observed in cases with non-drug-induced coma (6,15), and in such cases can be interpreted as a drug side effect in the absence of coma (7).…”

Section: Discussionmentioning

confidence: 99%

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Immunohistochemical investigation of the coma blister and its pathogenesis

et al. 2013

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: The erythematous patches and vesicles that are observed in coma patients, usually from an overdose of medication, are known as coma blisters. However, it is unknown whether the degenerated sweat gland is a necrosis or apoptosis. We immunohistochemically examined such skin lesions to investigate the characteristics and pathogenesis of the coma blister. Skin lesions were obtained from a forensic autopsy case, a woman in her thirties, of caffeine intoxication. Those lesions were observed in the left femoral, the lower left thigh, and the right knee. Histologically, the skin lesions showed that the keratinocytes had necrosed and the epidermis was thin in some areas. Eccrine sweat gland degeneration was observed. Obvious inflammatory cell infiltrations were not detected. Immunohistochemically, we stained each skin lesion against CD3, CD8, CD45RO, cytokeratin, 70 kD heat shock protein, ubiquitin, 150 kD oxygen regulated protein, and caspase-cleaved keratin 18 neo-epitope M30. They were also stained with an in situ apoptosis detection kit. Degenerated sweat glands featured CD45RO and M30 immunoreactivity. Immunohistochemical staining for CD45RO, CK-L, and M30 might be useful to observe sweat gland degeneration in the coma blister. Therefore, the apoptosis might be related to coma blisters and sweat gland degenerations. J. Med. Invest. 60 : 256-261, August, 2013

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Section: Discussionmentioning

confidence: 99%

“…The erythematous patches and vesicles that are observed in coma patients, usually from an overdose of medication, are known in the dermatology field as coma blisters (3)(4)(5). Recently, it had been reported that a similar spiloplaxia and vesicles are also observed in non-coma cases (6,7).…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical investigation of the coma blister and its pathogenesis

et al. 2013

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“…2). [2] reported that bullous lesions had been noted in patients with barbiturate intoxication, which they thought to be due to the primary toxic action of this drug on the epidermis. However, Freeman and Raza [3] demonstrated 2 cases of bullous lesions associated with coma due to neurological disorders in the absence of barbiturates.…”

Section: Case Reportmentioning

confidence: 99%

A Case of Trophoneurotic Bullae

Horiguchi¹,

Imamura²,

Tanaka

1983

Dermatology

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“…Barbiturates might pro voke bullous eruptions as a result of overdosage and in toxication [1,2,10]. The blisters are subepidermal with degeneration of the overlying epidermis [1], There are no reports that phénobarbital might induce pemphi gus.…”

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confidence: 99%

“…The frequency of bullous eruptions in patients tak ing barbiturates varies from 6.5% [2] to 50% [1], The histological picture of the drug-induced bullous erup tions may resemble also erythema multiforme [1). It has been suggested that the cause of these changes is the direct toxical damage of the skin capillaries by the barbiturates [1].…”

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confidence: 99%