Treatment of chronic bullous disease of childhood.

Chronic bullous disease of childhood (CBDC) is generally a self-limited disease of prepubescent children that resolves within months to years. However, as discussed in the previous issue of Dermatologic Clinics, the disease is associated with significant morbidity and usually requires systemic therapy. Treatment is aimed at controlling blistering while avoiding adverse reactions. There are several anecdotal reports of treatment options, but controlled or comparative studies are lacking. This article discusses the management options of CBDC in more detail.

Clinical features, diagnosis, and pathogenesis of chronic bullous disease of childhood.

Chronic bullous disease of childhood (CBDC) is the most common acquired autoimmune blistering disorder of childhood and is characterized by linear IgA staining of the basement membrane zone on direct immunofluorescence. This autoimmune attack on structural proteins, usually proteolytic fragments of collagen XVII, renders the dermal-epidermal junction prone to blistering. Diagnosis is confirmed by characteristic histology and direct immunofluorescence. Prognosis is generally favorable, with spontaneous remission usually occurring by puberty; however, cases with severe morbidity and cases persisting into adulthood have been reported. This article discusses the clinical features, diagnosis, and pathogenesis of CBDC in more detail.

Silver sulfadiazine therapy in widespread bullous disorders: potential for toxicity.

Silver sulfadiazine (SSD) cream, most known for its use in the treatment of extensive burn wounds, is commonly used in the management of erosions in bullous disorders. The beneficial antibacterial effect of SSD use is not without risk, as silver toxicity has been well documented in burn patients. Renal insufficiency accelerates silver accumulation and thus toxicity. Data on silver toxicity in patients with primary blistering disorders is scarce; however the literature regarding silver toxicity in burn patients may be applicable to patients with bullous diseases. Hence we recommend that clinicians exercise caution when prescribing protracted wound care with SSD for blistering disorders.