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Abstract: A 5-month-old male infant with a large number of blisters, macules, and individual blister ruptures accompanied by localized erosions and oozing on the skin surface is a hereditary predisposition to maculopapular epidermolysis bullosa. This disease is recommended to actively hospitalized, choose to use antibiotics topical drugs with vitamins, hormones and incubator for comprehensive treatment, about 15 days can be the symptoms will basically subside.
Basic information】Male, 5 months
Disease Type】Epidermolysis Bullosa
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】April 2022
Treatment plan】Non-adhesive synthetic dressing + medication (mupirocin cream, vitamin E, dexamethasone) + incubator
Treatment period】15 days of hospitalization
【Treatment effect】The overall symptoms basically disappeared
I. Initial consultation
At the end of April, the epidemic in Harbin was finally relieved to some extent, and I was called by the pediatric department for consultation during my outpatient visits. From the parents’ words, we know that the affected child is now 5 months old and the blisters and macules on the skin surface have been persisting for 3 days. The skin surface was just a small bump in the early stage, which rapidly turned into blisters in the later stage, and large blisters with a diameter of more than 2 cm were visible at the root of the thigh. The blister on the surface of the right calf, after mild friction, the blister ruptured and left a vesicular surface, according to the overall situation of the child to the pediatrician issued a consultation opinion, consider the diagnosis of herpetic epidermolysis bullosa, after communication with the pediatrician and the family of the patient, the family agreed to perform dermatopathological examination in order to clearly diagnose dermatopathology, immunohistochemical results show that the blister is located in the epidermis, the basal layer is visible fissures, electron microscopy is visible The immunohistochemical results showed that the blisters were located within the epidermis, with fissures visible in the basal layer and thick tension filaments visible on electron microscopy. The pathological results were consistent with the diagnosis of herpetic epidermolysis bullosa.
II. Treatment history
Epidermolysis bullosa is a rare genetic disease that requires hospitalization, especially for a 5-month-old child. Due to the severity of the symptoms, the child was treated with primary care, wound protection, friction reduction, loose clothing, non-adherent synthetic dressings, topical antibiotic ointment, topical mupirocin cream on the skin surface, oral vitamin E, and intravenous dexamethasone injection in an incubator. The child’s parents accompanied the child throughout the whole process and took good care of the child.
III. Treatment effect
After 7 days of treatment, the blisters, skin surface erosion and exudation of the child were mildly improved. After 15 days, the overall symptoms basically disappeared and the child was discharged from the hospital. The parents described that the blisters and blisters on the skin surface of the child did not appear again, and the child had a normal body temperature, good mental status and good diet.
Precautions
We are glad that the child’s condition has improved after this treatment. After the appearance of this disease, large blisters, ruptures and erosions will appear on the skin surface, and the trauma will easily cause infection. After the child is discharged from the hospital, parents should not touch the child’s skin with any topical medications other than those prescribed by the doctor for a short period of time. If the child’s temperature fluctuates abnormally, or if other uncomfortable symptoms appear, it is important to follow up with the doctor in a timely manner.
V. Personal insight
Epidermolysis bullosa can be subdivided into epidermolysis bullosa simplex, epidermolysis bullosa limited, epidermolysis bullosa herpetiformis, epidermolysis bullosa junctional, and many other categories. When this disease is clinically suspected, a pathological examination is promptly chosen, which requires a combination of mutation localization, electron microscopic studies, immunofluorescence, and many other tests to make a definitive diagnosis. After the symptoms of the disease are completely cured, it is possible that the disease may recur after a period of time. Parents should pay sufficient attention to the appearance of similar symptoms in their children, treat the symptoms promptly, and follow up in case of recurrence.