Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Bullous reaction; unusual presentation

Discussion in 'General Issues and Discussion Forum' started by Mart, Aug 25, 2010.

Tags:
  1. Mart

    Mart Well-Known Member


    Members do not see these Ads. Sign Up.
    I had a referral from dermatology recently for consideration of possible mechanical cause for episodic bullous reaction in 66 yo female.


    I was unable to find any likely cause of friction or stress from abnormal foot behavior during stance or gait and footwear fits well.
    There was no prodromal itching or pain and lesion started at apex of the toe. The lesion base is sensitive but painless without pressure. Problem has been episodic approximately annually for several consecutive years; there is no interesting medical history, known drug allergies or unusual medications. She had her annual episode 2 days ago.

    Some pics to look at below.

    If this was a more widespread distribution or constant problem I might be suspicious for some kind of bullous pemphigoid reaction but not aware that this might present in such an episodic way. Not sure if she has been assayed for autoantibodies.
    I aspirated the bulla and sent fluid for culture to rule out dermatophytes or other micro-orgs.

    Anyone care to comment, speculate etiology or further diagnostic approach?

    Image #1 Tuesday, August 24, 2010.JPG

    Image #2 Tuesday, August 24, 2010.JPG

    Image #3 Tuesday, August 24, 2010.JPG

    #4 Tuesday, August 24, 2010.JPG



    Cheers
    Martin
    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  2. footsiegirl

    footsiegirl Active Member

    If the blisters dont occur anywhere else, then I would think Pemphigoid unlikely- even less likely if it happens "annually".

    Annually suggests fungal or else perhaps a reaction to the nail art ingredients? It would be interesting to see whats under the nail polish

    Any one else?
     
  3. Catfoot

    Catfoot Well-Known Member

    All,
    I would speculate either,

    1. Bullous pemphigiod (limited presentation) or

    2. Allergic reaction, caused by something that she only comes into contact with yearly, say on her annual holiday.

    This is Blinda's area of expertise, maybe she can throw some light on this ?

    CF
     
  4. Mart

    Mart Well-Known Member

    Thanks for comments. I checked back on my notes; she reported 5 previous episodes all in August on yearly basis except one in Feb.

    In Winnipeg you dont venture outdoors barefoot in Feb unless bonkers and she isn't; I think this makes outdoor environmental allergen unlikely.
    Nail polish? I thought about. If this were likely why only single toe? Also I am pretty sure this was not present in previous episode.

    Will post any diagnostic progress.

    cheers

    Martin

    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  5. blinda

    blinda MVP

    No, not an expert, just an interest in dermatology.

    Nice pics :drinks

    I would imagine that as the referral was FROM dermatology they would have ruled out BP as they would probably have performed blood tests and checked for antibodies along the basement membrane.

    You say she has unremarkable meds and no known drug allergies, but there are some `regular` meds that are capable of causing fixed eruptions (FE). Such as paracetamol, A/B`s, NSAIDS, some sedatives and even quinine.

    That said, I`m with the others, I reckon it`s probably a reaction to the nail art....she only has jewels and stuff on that toe. Cant think of reason for
    annual episodes other than she has pedicures/art work during August?

    I`d be very interested to know the results of the culture.

    Cheers,
    Bel
     
  6. carolethecatlover

    carolethecatlover Active Member

    Nice nail art. There's a nasty chemical used in fake acrylic nails, MDMA? Also a swop with acetone, And she went to a foot spa? YUK!! Since I did the manicure and pedicure course, subjecting myself to the misplaced humor on this site, I would never go near one...Bug heaven The episode inFeb? Did she take a cruise that year?
     
  7. Mart

    Mart Well-Known Member

    Thanks Bel . . . . good points....... I check her for any recollection for prior spa use or associated episodic drug use.


    cheers

    Martin


    The St. James Foot Clinic
    1749 Portage Ave.
    Winnipeg
    Manitoba
    R3J 0E6
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
  8. jane.e.benson

    jane.e.benson Active Member

    Hya,
    I beleive it could well be reaction to insect bites, i know of two people in england that have very similar reactions, and i think local circulation causes hallux to be the weaker point. (As for feb outbreak, although cold in your area is it possible that the odd insect survives?)
    jane
     
Loading...

Share This Page