Phenobarbital-induced bullous lesions in a non-comatose patient

The occurrence of dermatologic bullous lesions is well documented after barbiturate-induced intoxication. However, this rare clinicopathological entity is only reported in the setting of a coma or lethal toxicity. This case report presents a case of a noncomatose, nonimmobilized patient who developed systemic bullous lesions after an acute ingestion of oral phenobarbital. This case illustrates that bullous lesions can occur as a result of nontoxic phenobarbital doses, in the setting of subtherapeutic barbiturate blood levels. All previous case reports suggest phenobarbital produces either systemic bullae only after coma-inducing doses or a localized bullous reaction after a high-dose intravenous injection. This case challenges this previously held association. Although the exact mechanism of the bullous lesions remains unknown, the clinical course of the lesions is self-limiting and does not require additional care beyond the treatment of a superficial burn. Resolution of the bullae occured within two weeks. Since phenobarbital continues to be prescribed orally, physicians should recognize bullous lesions as a potential adverse dermatological reaction from non-lethal oral doses of phenobarbital.