Recently I saw this 40 year old woman who presented with severe blisters and erosions. It started about 3 weeks ago and spread quite rapidly from the chest to the face and extremities. Now her mouth is also involved.
Exam: generalised bulla, majority are flaccid type. Erosions extensive with crusts esp anterior chest wall. Superficial erosions on the lower lips. Nikolysky sign positive.
Skin biopsy: Section shows skin composed of epidermis and dermis. A suprabasal bulla
containing acantholytic cells is seen. In areas, a tombstone appearance
is seen. Infiltrates of eosinophils and lymphocytes are seen in the
Blood counts and biochemistry are normal.
She was treated as outpatient. I have started her on oral prednisolone 40mg daily. Added oral antibiotics cefuroxime 250mg bd. Skin dressing with KMNO4 wet compress followed by fusidin/hydrocort cream bd. Keep skin roof intact.
- I do not have IF facilities. Will this lack of facilities affect her prognosis?
- what kind of skin dressing would you use?
- would you use steroid sparing agent like mycophenolate, MTX , azathioprine or ritazulimab at this juncture?Thanks for your help. Your comments are greatly valued.
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