57-year-old man • type 2 diabetes • neuropathy • bilateral foot blisters • Dx?

Porphyria tends to develop on the hands, whereas BD most commonly occurs on the feet.⁵

Erythema multiforme typically includes inflammatory skin changes.⁵

Trauma or fixed drug eruption as a cause of blistering lesions would be revealed during history taking.

Considerations for treatment and follow-up

Without treatment, blisters often self-resolve in 2 to 6 weeks, but there is high likelihood of recurrence.^6,8 There is no consensus on treatment, although a typical course of action is to deroof the blister and examine the area to rule out infection.⁶ The wound is then covered with wet-to-dry gauze that is changed regularly. If there is suspicion for or signs of underlying infection, such as an ulcer or skin necrosis, antibiotics should be included in the treatment plan.⁷

Additional considerations. Patients will often need therapeutic footwear if the blisters are located on the feet. Given the higher prevalence of microvascular complications in patients with diabetes who develop BD, routine ophthalmologic examination and renal function testing to monitor for microalbuminuria are recommended.⁵

Our patient underwent bedside incision and drainage and was discharged home with appropriate wound care and follow-up. 

THE TAKEAWAY

BD cases may be underdiagnosed in clinical practice, perhaps due to patients not seeking help for a seemingly nonthreatening condition or lack of clinician recognition that bullae are related to a patient’s diabetes status. Prompt recognition and proper wound care are important to prevent poor outcomes, such as ulceration or necrosis.

CORRESPONDENCE
Kathleen S. Kinderwater, MD, 101 Heart Drive, Greenville, NC 27834; salmondk19@ecu.edu