CASE REPORT Electrical stimulation-induced bullous formation in a pemphigoid diabetic patient: a case report Z. Annabestani & Sh. Mohseni & G. Torkaman & F. Nasirpoor & B. Larijani & M. R. Mohajeri-Tehrani Received: 4 March 2012 /Accepted: 14 May 2014 # Research Society for Study of Diabetes in India 2014 Abstract In 2002, the use of electrical stimulation was ap- proved as an adjuvant treatment for non-healing ulcers. A 50- year-old man with type 2 diabetes of 3 years’ duration was referred to our diabetic foot clinic. The patient was a known case of bullous pemphigoid (BP) for the past 15 years and was under steroid therapy (20 mg/day Prednisolone). Electrical stimulation was used as one of the ancillary methods for the treatment of his chronic diabetic foot ulcers. After two ses- sions, physical examination revealed a bullous eruption (ap- proximately 14 cm) on an erythematous base in the right leg. The literature is devoid of any case of bullous induced by electrical stimulation in pemphigoid diabetic patients. Further studies are required to validate our observation and fully explain the pathogenesis. Keywords Bullous pemphigoid . Electrical stimulation . Adverse effect Introduction Electrical stimulation is an adjuvant therapy that involves the placement of electrodes in direct contact or in close proximity to the skin wound. In 2002, the use of electrical stimulation was approved as an alternative treatment for non-responding ulcers (such as diabetic, venous ulcers, etc.) [1]. Case report In August 2011, a 50-year-old man with type 2 diabetes of 3 years’ duration was referred to our diabetic foot clinic. The patient was a known case of bullous pemphigoid (BP) for the past 15 years and was under steroid therapy (20 mg/day Prednisolone). Also, he had an 8-month-old chronic non- healing neuropathic ulcer, 2×2cm 2 in diameter and 2 cm in depth (grade II Wagner’ s classifications), in his right sole (Fig. 1). Informed consent was obtained from the patient after he had been provided with comprehensive explanation about electrical stimulation as one of the ancillary methods for the treatment of chronic diabetic foot ulcers. Cathodal electrical stimulation with the sensory threshold intensity was delivered to the right leg. The cathode was placed in the distal region (near the wound) and the anode was positioned on the proximal region of the leg. The safety of the intensity applied was ensured by comparing the ratio of the sensory threshold of the forearm/leg in the patient to that previously obtained in a healthy matched group. The patient received electrical stimulation for 60 min every other day. Z. Annabestani Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 5th Floor, Shariati Hospital, North Kargar Ave., Tehran, Iran e-mail: zohreh_nn@yahoo.com S. Mohseni : B. Larijani : M. R. Mohajeri-Tehrani (*) Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran e-mail: mrmohajeri@tums.ac.ir S. Mohseni e-mail: sh_mohseni58@yahoo.com B. Larijani e-mail: larijani@tums.ac.ir G. Torkaman : F. Nasirpoor Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran G. Torkaman e-mail: torkamg@modares.ac.ir F. Nasirpoor e-mail: nasiri.maedeh@yahoo.com Int J Diabetes Dev Ctries DOI 10.1007/s13410-014-0212-0