From the Guidelines
Treatment for Postoperative Bullous Eruptions
Treatment for postoperative bullous eruptions typically involves a combination of supportive care and pharmacological interventions.
- Topical corticosteroids, such as clobetasol propionate 0.05% ointment, applied twice daily for 7-10 days, may be used to reduce inflammation 1.
- In cases where blisters are large or troublesome, they may be pierced with a sterile needle to release fluid, but the blister roof should be left in place to prevent infection 1.
- For symptomatic bullae or erosions, initiation of class 1 high-potency topical steroid and reassessment every 3 days for progression or improvement is recommended 1.
- In severe cases, oral steroids such as prednisone at 0.5-1 mg/kg/d dosing and tapering over at least 4 weeks may be necessary 1.
- General local wound care, including plain petrolatum ointment and bandages, should be provided to promote healing and prevent infection 1.
- It is also important to monitor patients closely for progression to greater body surface area involvement and/or mucous membrane involvement, and to consider consulting with dermatology for further guidance 1.
- The use of antiseptics, such as potassium permanganate, may be considered for extensive areas of erosion to dry the lesions and prevent infection 1.
- In cases of bullous pemphigoid, steroid-sparing options such as IVIG and rituximab may be considered as an alternative approach to treating the condition 1.
From the Research
Treatment for Postoperative Bullous Eruptions
The treatment for postoperative bullous eruptions, specifically bullous pemphigoid, involves various approaches. Some of the key treatments include:
- Oral steroids, which are the standard treatment 2
- Topical steroids, such as clobetasol propionate cream, which may be as effective as oral steroids and cause less mortality 2
- Doxycycline, an oral anti-inflammatory antibiotic, which may be less effective than prednisolone but causes less mortality 2
- Dapsone, which can be used in combination with systemic and topical corticosteroids as a relatively safe and effective treatment option 3
- Protein A immunoadsorption, which can be an effective adjuvant treatment option for severe and/or refractory bullous pemphigoid 4
Specific Treatment Regimens
Some specific treatment regimens that have been studied include:
- Clobetasol propionate cream applied over the whole body, which may increase skin healing and reduce mortality compared to oral prednisone 2
- A mild regimen of topical clobetasol propionate, which may be as effective as a standard regimen and have similar mortality 2
- Doxycycline compared to prednisolone, which may decrease mortality and improve quality of life 2
- Dapsone in combination with methylprednisolone and topical clobetasol propionate, which may be a relatively safe and effective treatment option 3
Wound Care and Management
In addition to these treatments, proper wound care and management are crucial in preventing complications such as surgical-site infections and wound dehiscence 5. This includes timely review of the wound, appropriate cleansing and dressing, and early recognition and active treatment of wound complications.