From the Guidelines
Blistering wound disease requires prompt medical attention and treatment, which may include corticosteroids like prednisone, topical antibiotics, and wound care to prevent infection and promote healing, as the mortality rate for pemphigus vulgaris, a type of blistering disease, was significantly reduced from 75% to 1-42% with the introduction of corticosteroids 1.
Treatment Overview
The treatment of blistering wound disease depends on the specific type and severity of the condition. For mild cases, gentle wound care and topical antibiotics may be sufficient, while more severe cases may require oral antibiotics, corticosteroids, or other immunosuppressive medications.
- Gentle cleansing with mild soap and water
- Application of petroleum jelly and non-stick bandages
- Topical antibiotics like mupirocin (Bactroban) applied 2-3 times daily for 7-10 days
- Oral antibiotics such as cephalexin (500mg four times daily for 7-10 days) or doxycycline (100mg twice daily for 7-10 days) for more severe cases
- Corticosteroids like prednisone (starting at 0.5-1mg/kg/day) for autoimmune blistering diseases
Disease Management
Proper diagnosis and management of blistering wound disease are crucial to prevent complications and improve outcomes.
- The use of intravenous immunoglobulins (IVIg) has been reported to be effective in some cases of blistering disease, particularly in patients with severe, unstable steroid-dependent pemphigoid 1.
- The definitions and outcome measures for mucous membrane pemphigoid, a type of blistering disease, have been established by an international panel of experts, which includes the use of minimal therapy, such as dapsone, prednisone, and topical corticosteroids, to achieve disease control and remission 1.
Outcome Measures
The outcome measures for blistering wound disease include the control of disease activity, prevention of scarring, and achievement of remission.
- The time to control of disease activity, which is the time interval from baseline to the control of disease activity, is an important outcome measure 1.
- The presence of transient new lesions that heal without scarring within 1 week while the patient is receiving minimal therapy for at least 2 months is considered a partial remission on minimal therapy 1.
- The absence of new or established lesions while the patient is receiving minimal therapy for at least 2 months is considered a complete remission on minimal therapy 1.
From the Research
Blistering Wound Disease Overview
- Blistering wound diseases are a group of rare and potentially debilitating disorders characterized by mucosal and cutaneous bullae formation 2, 3.
- These diseases can affect both skin and mucous membranes, varying in presentation, clinical course, pathohistology, immunopathology, and treatment 3.
Types of Blistering Wound Diseases
- Pemphigus, paraneoplastic pemphigus, bullous pemphigoid, cicatricial pemphigoid, epidermolysis bullosa acquisita, dermatitis herpetiformis, linear IgA bullous disease, porphyria cutanea tarda, and subcorneal pustular dermatitis are some of the blistering diseases 3.
- Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two of the most severe dermatologic conditions, often requiring inpatient care 4, 5, 6.
Treatment and Management
- Topical therapy is suitable for mild and moderate disease activity, while systemic treatment is considered for more extensive involvement 2.
- Corticosteroids remain the first-line systemic therapy for patients with moderate to severe bullous pemphigoid and pemphigus vulgaris, but steroid-sparing agents are invaluable in inducing long-term remission while minimizing steroid-associated side effects 2.
- Supportive care is the most universally accepted intervention for SJS/TEN, with adjuvant therapies used in severe cases, but the data is underwhelming and underpowered 4, 5.
- A combination of supportive care and possible topical and systemic therapies, including corticosteroids, immunoglobulins, cyclosporine A, and TNF-alpha blockers, is recommended for SJS/TEN 5, 6.