Bullous Diseases in the Perioperative Setting: Anesthetic Considerations
1Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Cureus
|January 19, 2026
Summary
Anesthetic care for bullous skin disorders requires careful planning due to fragile skin and potential systemic issues. This review highlights atraumatic handling and airway strategies for these high-risk patients.
Area of Science:
- Anesthesiology
- Dermatology
- Systemic Disease Management
Background:
- Bullous skin disorders present unique anesthetic challenges.
- Limited evidence exists for perioperative management in these patients.
Purpose of the Study:
- To synthesize contemporary data on anesthetic and perioperative strategies for patients with autoimmune and inherited bullous diseases.
- To identify evidence-based practices for managing patients with bullous skin disorders.
Main Methods:
- Systematic review of English-language studies from 2015-2025.
- PROSPERO-registered review (CRD420251160409).
- Included 26 studies reporting perioperative management.
Main Results:
- Identified 17 intraoperative precautions focused on minimizing trauma (e.g., padding, lubrication).
- Airway strategies emphasized equipment lubrication and tape-free fixation.
- Broader systemic considerations included metabolic, cardiovascular, and renal issues.
Conclusions:
- Atraumatic handling, meticulous airway planning, and individualized multisystem assessment are crucial.
- No standardized guidelines currently exist.
- Further prospective studies are needed to establish evidence-based protocols.
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