Pruritic blisters on legs and feet
Was recent outdoor fieldwork to blame for the pruritic blisters on this US Navy sailor’s feet and calves?
Focus on symptoms and prevention
BABR will resolve over time without aggressive intervention. Most patients are treated symptomatically with oral anti-histamines and topical steroids for pruritus.1 Prevention of further bites is important because of the risk of arthropod-transmitted diseases.21
Our patient couldn’t comfortably wear shoes
Our patient had extensive tense blistering on both legs that prevented him from comfortably wearing shoes (FIGURE 2). Using a #11 blade, we punctured all of the blisters at the most dependent portion of each lesion. We decompressed the lesions, but did not de-roof them so that the blistered skin could serve as a biological dressing. We applied topical mupirocin and wrapped both legs with a compressive dressing.
We gave the patient a 2-week tapering course of oral prednisone. At the 3-week follow-up, all of the blistered skin had completely healed with the exception of post-inflammatory hyperpigmentation. No new lesions developed. Our patient was well, with no recurrence of blistering, at his 6-month follow-up.
FIGURE 2
Wearing shoes was a problem
Correspondence
Kendall Lane, MD, Expeditionary Health Services Pacific, 3985 Cummings Rd, Suite 4, San Diego, CA 92136; kendall.lane@navy.mil
