Bullous Disease of Diabetes (Bullosis Diabeticorum)

Acanthosis nigricans, acrochordrons, diabetic dermatopathy, necrobiosis lipoidica, and bullous diabeticorum are some of the cutaneous symptoms of diabetes. Bullous illness (bullosis diabeticorum) is a blistering, non-inflammatory condition of the acral skin. Diabetes bullous illness is more common in people who have had diabetes for a long time or who have many comorbidities. Although the actual cause is uncertain, it is likely to be multifactorial. Neuropathy, nephropathy, vasculopathy, and UV (ultraviolet) light are all suggested to have a role. BD is most likely caused by the various problems that come with poorly managed diabetes. The exact number of people who have BD is unknown. The majority of case studies in the literature were based on a small number of cases. Bullous diabeticorum is a restrictive diagnosis, which necessitates a histological study that includes direct immunofluorescence to rule out other vesicobullous illnesses. In terms of BD management, no strong consensus has formed. The blisters have historically been thought to be self-limiting, with bullae resolving in 2 to 6 weeks if left untreated. In some cases antibiotic may be used. In this article we’ll be looking at Bullosis Diabeticorum. Its etiology, epidemiology, diagnosis, and treatment.

Pharyngeal Ulcer as the First Sign of Pemphigus

Pemphigus is a rare autoimmune mucocutaneous bullous disease that can be life-threatening. We report a case of pemphigus vulgaris with pharyngeal ulcer as the initial presentation that was treated with glucocorticoid therapy.

Bullous pemphigoid: Case report and review of literature​

Bullous pemphigoid (BP) is an autoimmune bullous disease characterized by subepithelial blistering mostly affecting elderly but may be seen in all ages. A 52-year-old female patient came with a chief complaint of itching, redness and ulcer in the hands and oral cavity for the past 2 weeks. The examination revealed ulcer- ated lesions in palate and buccal mucosa. Erythematous lesions were also seen in upper limb. Incisional biopsy was done and histological examination revealed bullous pemphigoid. The patient was immediately started with systemic and topical steroids and was continued for 3 weeks. The extra-oral lesions were healed and intraoral ulcerations subsided after 3 weeks.

The epidemiology of autoimmune bullous diseases in Sudan between 2000 and 2016

Objectives Autoimmune bullous diseases vary in their clinico-epidemiological features and burden across populations. Data about these diseases was lacking in Sudan. We aimed to describe the epidemiological profile and to estimate the burden of autoimmune bullous diseases in Sudan. Methods This was a retrospective cross-sectional study conducted at Khartoum Dermatological and Venereal Diseases Teaching Hospital. We used routinely collected health care data, and included all patients with an autoimmune bullous disease who presented to the hospital between 2001 and 2016. Results Out of the 4736 patients who were admitted to the hospital during the study period, 923 (19.5%) had an autoimmune bullous disease. The average rate of patients at the hospital was 57.7 per year representing 1.3 per 100,000 population per year. After exclusion of patients where the final diagnosis was missing, 585 were included in the further analysis. Pemphigus vulgaris was the most common disease (50.9%), followed by bullous pemphigoid (28.2%), linear IgA disease/chronic bullous disease of childhood (8.4%), and pemphigus foliaceous (8.2%). Pemphigoid gestationis and IgA pemphigus constituted 1.4% and 1.2% of the cohort, respectively. Paraneoplastic pemphigus, mucous membrane pemphigoid, lichen planus pemphigoidis, bullous systemic lupus erythematosus, and dermatitis herpetiformis were rare. None of the patients had epidermolysis bullosa acquisita. Conclusions The clinico-epidemiological characteristics vary among the types of autoimmune bullous diseases. Females were more predominant in most of them. Sudanese patients tended in general to present at a younger age than other populations. The pool of Sudanese patients with autoimmune bullous diseases is large which requires investigation for the local risk factors and presents a field for future trials.

Anti-P 200 pemphigoid – The most common floor binding subepidermal autoimmune bullous disease in a tertiary care center in south India

Background: The pemphigoid group of diseases may present clinically and immunologically in a very similar fashion. Indirect immunofluorescence microscopy with readily available salt-split human skin in a BIOCHIP™ helps to classify these conditions as those with either with roof binding or floor binding of immunoreactants. Epidermolysis bullosa acquisita, anti-laminin 332 pemphigoid and anti-p200 pemphigoid show floor binding, while in the most frequent type of pemphigoid disease, bullous pemphigoid, epidermal side staining pattern is seen on salt-split skin Aims: The aim of the study was to detect the target antigens in sub-epidermal bullous diseases. Methods: Forty patients with bullous pemphigoid diagnosed by lesional histopathology and direct immunofluorescence microscopy were re-evaluated by a BIOCHIP™ mosaic containing both tissue substrates and recombinant target antigens. Sera with floor pattern staining on salt-split skin were further evaluated by immunoblotting with dermal extract. Results: Five patients with floor staining had anti-p200 pemphigoid. Limitations: We could not perform serration pattern analysis of direct immunofluorescence in our patients. Conclusion: Histopathology and direct immunofluorescence microscopy cannot differentiate between various entities of pemphigoid diseases. A multivariant approach using a BIOCHIP™ mosaic including salt-split skin followed by immunoblotting with dermal extract helps to identify the target antigen.

Combination of vaping, cannabis and smoking exposure: shorter time to bullous lung disease and pneumothorax

We present a 25-year-old Hispanic man with left-sided pleuritic chest pain and dyspnea for three days. His Chest radiograph and CTA revealed bilateral apical bullous disease with a 2.5 cm deep left sided pneumothorax. He was managed with 100% oxygen via non-rebreather mask and did not require invasive decompression. Patient reported a one-year history of vaping along with tobacco and cannabis smoking exposure from his late teen years. The pneumothorax improved and he was discharged to the pulmonary clinic. The authors review the multiplicative effect of vaping on smoking cannabis and tobacco leading to early apical bullous lung disease. Patients with such significant smoking/vaping history may benefit from prolonged pulmonary and addiction medicine follow-up given the clinical bullous lung disease and risk for continued smoking/vaping. The case emphasizes the potential exponential effect of combining vaping with tobacco and marijuana smoke on lung health leading to disease at extremely young ages.

A RARE AND INTERESTING PRESENTATION OF EMPHYSEMATOUS BULLAE

The term bullous disease is reserved for multiple bullae in lungs that are otherwise normal.This entity is different in etiology and pathogenesis from that in which bullae occur in conjunction with underlying chronic obstructive pulmonary disease (COPD).The present report is regarding a case of emphysematous bullae in a 31 yr old female in right lower lobe.The patient underwent right lower lung segmental resection where fungal ball was found intraoperatively and was removed.The patient had an uneventful recovery postoperatively