Bullous hemorrhagic

WolfR, Elman M, Brenner S. Sulfonamide-induced bullous hemorrhagic eruption in apatient with low prothrombin time. IsrJMedSci (1992) 28, 882-4. 

Bullous hemorrhagic dermatosis is a rare adverse reaction to subcutaneous heparin [115 116" ]. 

The nurse informsthe primary health care provider immediately if a skin rash occurs. The use of phenytoin is usually discontinued if a skin rash occurs. If the rash is exfoliative (red rash with scaling of the skin), purpuric (small hemorrhages or bruising on the skin), or bullous (skin vesicle filled with fluid, ie, blister) use of the drug is not resumed. If the rash is milder (eg, measles-like), therapy may be resumed after the rash has completely disappeared. 

Bullous pemphigoid has been reported in an 84-year-old man after topical therapy with fluorouracil 1% solution daily over several days for actinic keratosis. All treated lesions became bullous, with the development of a few bullae on untreated areas of normal skin. Bullous lesions were pruritic and sore and some contained hemorrhagic fluid. There was a leukocytosis (11.7 x 10 /1). The blister fluid contained predominantly eosinophils, and immuno-fluorescent studies of the serum and blister fluid showed anti-basement membrane antibody titers of 1 640 and 1 160 respectively. Fluorouracil was discontinued and the patient was treated with steroids and saline compresses, with abatement of symptoms (119). 

When penicillamine is administered for a long time and in high doses (for example for Wilson s disease) it can cause a characteristic delayed skin eruption, with increased friability, hemorrhagic bullous lesions, and miliary papules (66,260-266). The lesions develop predominantly in those parts of the skin that are often exposed to trauma. This disorder is a manifestation of the effects of penicillamine on collagen and elastin. Occasionally, these eruptions imitate other rare... 

There is a broad spectrum of signs and symptoms associated with acute short-acting barbiturate toxicity. Lethargy, ataxia, nystagmus, diplopia, amnesia, slurred speech, confusion, hypotonia, hypotension, hypothermia, hypoglycemia, coma, respiratory depression, and death have been reported. Comatose patients may develop erythematous or hemorrhagic bullous skin lesions primarily over areas of pressure (e.g., elbows and knees). These lesions are commonly referred to as barb burns . Doses of 3-5 mg kg of most short-acting barbiturates will cause toxicity in children. The estimated potentially fatal dose in nondependent adults is 3-6 g. 

Pechlaner C+, Blood Coagul Fibrinolysis 12(6), 491 Bullous dermatitis (hemorrhagic)... 

The hemorrhagic type is the commonest and conforms to the classical picture of Schonlein-Henoch purpura. The main feature of the condition are petechial haemorrhages, ranging from pinhead- to coin-size and appearing preferentially on dependent parts of the body. Urticarial lesions may accompany the purpura. In severe cases there are also vesicular, bullous, and ulcerating lesions. 

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