bullous pemphigoid

  1. 0
    hello

    i have a patient who have been diagnosed with bullous pemphigoid. she has multiple blisters and it breaked open and now she has this huge open sores in her body. right now we are just applying steroid creams to those sores and we are to leave them open to air but i'm afraid they are going to get infected. does anyone have experience treating sores related to bullous pmphigoid? how do you treat open sores? do you leave it open? do you cover it with dressing? do you use any other cream or ointment? thanks for any info.
  2. 6 Comments so far...

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    Hi! My patient has it and if he wears pants, I use non-adherant or foam dressings and wrap with kerlix and when its on the body, I just apply the non-adherant or foam to the area with the ointment and it holds on for a while. Bactoban is used on the open lesions and clobetasol to the closed. I also notice blisters form quickly if tape is applied directly on skin. He's been living with it for 6 months and not once has any gotten infected.

    Hope this helps!
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    There was a show on the other night Mystery Diagnosis and it featured a young girl with this disease. It was pretty interesting. On the show they said the treatment was immunosupresants and steroids. They said her blisters healed pretty quickly after she got the proper treatment.
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    I take care of three patients with this disorder, about which too little is known. Clobetasol is used to relieve itching and pain caused by the immune factors that inundate the area of the blisters. I went through weeks and weeks of bandaging and dressing the blisters, spending over an hour a day on these patients. We finally realized that many of them are better left open to air in order to dry up and heal faster. The bacteria love those immune factors that seep out from the blisters, which are surely rich in proteins and aminos. It can be a catch-22: Adherent dressings cause trauma when removed, while nonadherent dressings trap moisture and occlude oxygen from the wound, leading to infection and cellulitis, etc.

    Cleaning every shift with NS and then drying with sterile guaze is very important if you are going to leave these blisters open to air. Keeping the patient off of the wounds is also important, it presents a skin risk that can open them to further complications. Airstream chucks pads work really well, we kept running out of both TIME and DRESSINGS keeping up with severe outbreaks. Better to let them lay on a clean breathable pad in comfort than to torture them with tape. One of these three had a tape allergy to top it off! So that's how we figured out these best practices... we had few other choices. The tape was causing it's own outlined blisters that peeled right off in the shape of where the tape was! Ouch... Open to air with close monitoring and infection control practices is the best way...

    Another exacerbating factor: daipers. Nix on the daipers. You will have to go head-to-head with managers since some will see it as a dignity issue so get the doctor on your side. You're already in for a fight once you tell your boss that you are going to leave open wounds undressed.

    One thing I'm curious about is whether Revina (trypsin/balsam peru/castor oil) is useful for treating the opened blisters. You would think it might be useful here but it is never prescribed from what I can tell. Is it due to the skin layer where these bullae occur not being the right locus?
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    I'm not totally up to speed on the etiology of this disease but I know that xenaderm or "revina" will serve to trap moisture in the area applied, while having an extremely mild debriding action. The basalm peru in some studies shows to increase blood flow but these studies were not FDA approved, so the product cannot claim this as a benefit. Just my
  7. 0
    Quote from ms.rn
    hello

    i have a patient who have been diagnosed with bullous pemphigoid. she has multiple blisters and it breaked open and now she has this huge open sores in her body. right now we are just applying steroid creams to those sores and we are to leave them open to air but i'm afraid they are going to get infected. does anyone have experience treating sores related to bullous pmphigoid? how do you treat open sores? do you leave it open? do you cover it with dressing? do you use any other cream or ointment? thanks for any info.
    bullous what??? this one's new for me, thanks for the interesting interventions, when i do see see this, i'll know what to do. no point reinventing the wheel.
  8. 0
    I had a patient with this once and I had never heard of it before. He was sent to the dermatologist who recommended large doses of prednisone and we applied silvadene to the areas. He had so many areas it was hard to dress all of them. We basicallly kept him in his room and just kept a clean sheet over him. I remember thinking that a burn cradle would have been the perfect thing to keep the covers from touching him. The blisters would dry up but more would come.


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