CLINICAL Blisters and homeopathy: case reports and differential diagnosis Gheorghe Jurj 1 and Silvia Waisse 2, * 1 Asociat ¸ia Rom^ an a de Homeopatie Clinic a, Timis ¸oara, Romania 2 Associac ¸ ~ ao Paulista de Homeopatia, S~ ao Paulo, Brazil Blisters are skin lesions characterized by accumulation of fluid between the layers of the skin. Their severity varies from the common blisters caused by friction to severe autoim- mune and congenital bullous disorders, some of them currently without treatment in con- ventional medicine or requiring drugs with potentially severe side-effects. This article reports cases of blistering diseases successfully treated with homeopathic medicines, which represent an alternative for the treatment of such disorders. Homeopathy (2011) 100, 168e174. Keywords: Homeopathy; Blisters; Pemphigus vulgaris; Atopic dermatitis; Bullous lupus; Toxic blisters; Bullous pemphigoid; Ranunculaceae Introduction Blisters are skin lesions characterized by accumulation of fluid between the layers of the epidermis and the dermis. Such disorders are classified as bullous diseases of the skin, which have autoimmune origin (Table 1), 1 and epidermol- ysis bullosa (EB) e a group of genetic bullous disorders where blisters are triggered by mechanical trauma. 2 Blis- ters also appear in dyshidrotic eczema and lupus erythem- atous bullous, besides the common blisters due to friction. 3,4 Diagnosis usually requires, besides clinical data, skin bi- opsy and immunologic tests, most commonly direct and in- direct immunofluorescence. Any blister-forming condition, by denuding the skin, may be complicated by infection. Treatment for autoimmune forms is based on corticoste- roids, and eventually immunosuppressant agents. 5,6 From a homeopathic standpoint, classifications and phys- iopathological mechanisms of production of blisters are less significant for the choice of suitable homeopathic medicines than the clinical presentation of the disease together with other factors allowing for the individualization of patients and homeopathic medicines. However, classical sources of homeopathic materia medica do not allow accurate distinctions between potentially useful medicines. The main reason is that most (if not all) works on homeopathic materia medica are discursive texts, while fine distinction between skin signs, in these case blisters, requires skilled ex- amination. As we know from semiotics, verbal (linguistic) and visual semiotic systems are irreducible one to another, translations between them cannot be carried out without los- ses. 7 The aim of this paper is to report cases of patients with some blister-affections successfully treated with homeopa- thy and to point to the particular traits that allow distinctions between homeopathic medicines. In a separate paper we will report cases of children suffering from EB. Case 1: pemphigus vulgaris in an adult A 38-year-old, female patient, diagnosed with pemphigus vulgaris (PV) 3 months before the first homeopathic consultation. The diagnosis was made at the dermatology department of the local hospital, which refused to release the results of biopsy and laboratory exams. Four weeks be- fore the initial outbreak of PV the patient had herpes labialis, which had been recurred several times in the previous year. Two months before the onset the patient developed itching in the arms. Blisters appeared initially in the hands, extending up the arms. They appeared at the beginning as confluent vesicles, and then became flaccid blisters up to 10 cm diam- eter, filled with clear, transparent fluid (Figure 1a). Stomati- tis appeared concomitantly (Figure 1b). The patient had been treated with several antibiotics and oral prednisone, with *Correspondence: Silvia Waisse, Rua Diogo de Faria 839, Vila Mariana, S~ ao Paulo, SP, CEP 04037-002, Brazil. E-mail: dr.silvia.waisse@gmail.com, swaisse@pucsp.br Received 17 April 2010; revised 6 January 2011; accepted 3 February 2011 Homeopathy (2011) 100, 168e174 Ó 2011 The Faculty of Homeopathy doi:10.1016/j.homp.2011.02.014, available online at http://www.sciencedirect.com