Massive Blisters

My wife has had both big toes swell up and blister without heat or other trauma happening to them.  The first blistered in late Oct 2003 and the other in late Feb 2004.  These blisters are big and blister the toe back to foot joint.  The Dr.'s have treated them as blister and gave antibiotics and covered them with silver sulfadiazine cream.  They eventually heal but they are very painful and makes walking difficult.  She doesn't wear tight shoes or footwear that normally agitates the feet.  She is 68 years old and is on blood pressure medicine and takes pain medication for migrane (migraine) headaches.  Any ideas what causes this blistering.  The fluid from these blisters was removed but not tested or analyzed.  What is the probability of this type of blister forming on the brain covering or the covering of any of the other critical organs in the body?  These blisters develop very rapidly.  She goes to bed in the evening and the next morning they are there.  They keep expanding for several days but they appear and grow to a substantial size in a few hours.  Thanks for you help.  I appreciate it.

[Alan Rockoff, MD]

Your wife needs a diagnosis.  The ones that come to mind are bullous impetigo, a staph infection, or bullous pemphigoid, an autoimmune skin disease.  Neither is serious, and neither affects internal organs.  Both need treatment, however, antibiotics in the first case and anti-inflammatory agents in the other.  There are other possibilities too, but every one I can think of just affects the skin, not the innards.

To find out what this is and what to do, please have your wife see a skin doctor.

Best.

Dr. Rockoff