ABSTRACT
Cutaneous blisters and/or bullae can occur in autoimmune disorders, infections, genetic diseases, and drug hypersensitivity. We present the case of a 62-year-old man with two autoimmune conditions who was admitted for antibiotic treatment of a lower extremity infection and suddenly developed a bullous rash. His physical examination was significant for tense, bullous lesions that involved his chin, palms, and inner thighs. Narrowing the differential diagnosis for patients with blistering skin lesions is imperative for timely and appropriate management.
Subject(s)
Anti-Bacterial Agents/adverse effects , Drug Eruptions/diagnosis , Skin Diseases, Vesiculobullous/diagnosis , Skin/drug effects , Vancomycin/adverse effects , Anti-Bacterial Agents/immunology , Diagnosis, Differential , Drug Eruptions/immunology , Drug Eruptions/therapy , Humans , Male , Middle Aged , Predictive Value of Tests , Risk Factors , Skin/immunology , Skin/pathology , Skin Diseases, Vesiculobullous/chemically induced , Skin Diseases, Vesiculobullous/immunology , Skin Diseases, Vesiculobullous/therapy , Vancomycin/immunologyABSTRACT
BACKGROUND: Acquired cold urticaria (ACU) is a form of physical urticaria that has been treated with first-generation antihistamines; there is a paucity of data regarding second- and third-generation antihistamines for the treatment of ACU. OBJECTIVE: To perform a systematic review of the literature to determine the efficacy of second- and third-generation antihistamines in the treatment of ACU. METHODS: Data were extracted via a MEDLINE search of the literature between 1950 and May 2009. We included double-blind, randomized, placebo-controlled studies comparing the treatment of patients with ACU with second- and third-generation antihistamine medications vs placebo. RESULTS: Overall, 98 patients were identified from 4 included studies. Two trials indicated that second- and third-generation antihistamines significantly eliminated the presence of wheals after treatment vs placebo (odds ratio [OR], 8.88; 95% confidence interval [CI], 4.35 to 18.13). Two trials demonstrated a reduction in wheal area after treatment with a second- or third-generation antihistamine compared with placebo (mean difference, -347.99 mm2; 95% CI, -489.43 to -206.54 mm2). Two trials demonstrated significant elimination of pruritus with second- or third-generation antihistamine treatment vs placebo (OR, 10.44; 95% CI, 4.39 to 24.84). All 4 studies assessed the tolerability of a second- or third-generation antihistamine vs placebo and found an increased rate of adverse events (OR, 3.04; 95% CI, 1.53 to 6.06), although the complaints were mild. CONCLUSIONS: The newer, less-sedating antihistamines seem to be effective in the treatment of ACU in terms of their ability to significantly reduce the presence of wheals and pruritus after cold exposure. These medications are usually well tolerated, with only mild adverse effects.
