Woman in her 70s with a past medical history of multiple myeloma, HTN, DM was admitted with fracture of fibula. She underwent open reduction with internal fixation. On the 8th post-op day, three large bullae were noticed on the front of the left thigh (Figure 1). There were no lesions elsewhere.
Given its acute and localized onset, and the fact that patient did not have any prior history of bullous disease, allergic contact dermatitis was suspected. When inquired, nurse had informed that patient had a foley stabilization kit (Figure 2) placed at the same site earlier. The lesions corresponded with the margins of the foley stabilization kit, raising suspicion that lesions could be due to allergic contact dermatitis to foley stabilization kit. The brochure given along with the foley stabilization kit, mentions that its use is contraindicated in people with known tape or adhesive allergy. Patient did have history of allergy to tape increasing our suspicion. A formal allergy challenge test was, however, not done.
Patient was treated with silver sulfadiazine cream and oral antihistamines. She was followed up to see if she had developed similar lesions. Patient did not develop any new lesions and existing lesions have begun to heal in the next couple of days.
Take home message: This case reiterates the fact that in all acute, localized bullous eruptions, allergic contact dermatitis should always be ruled out; more so if it occurs in hospitalized patients.
Figure: 1 Bullous lesions on front of the thigh
Figure: 2 Foley Stabilization Kit