Bullae in pediatric henoch schonlein purpura: why some patients develop them?

摘要

Bullae are rare skin manifestations in pediatric Henoch Schonlein purpura (HSP) patients. Why do some pediatric HSP patients develop bullae, while the majority of these patients do not? The recent article published in this journal (1) and some previous reports (2-4), including ours (4), may provide some suggestions: two possibilities may exist.The article by Abdulla et al (1) described an interesting case. Dominant dystrophic epidermolysis bullosa (DDEB) was diagnosed 1 year after the initial presentation of bullae in HSP: bullae in HSP uncovered the underlying DDEB or, rather, DDEB was proved to be the culprit of bullae in HSP.Quite recently, three research teams (2-4), including our team (4), reported pediatric HSP patients with bullae and also reviewed the literature. A publishing time delay between these three articles made each literature review incomplete. Combining all (1-4), there have been 22 reports describing 31 pediatric HSP patients with bullae. Prognoses of organ involvements were good in all 31 patients; occurrence of bullae did not indicate severe systemic diseases. Why then do some patients develop bullae?