{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T01:39:45Z","timestamp":1770687585903,"version":"3.49.0"},"reference-count":90,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T00:00:00Z","timestamp":1681171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Bullous pemphigoid (BP), the most common subepidermal autoimmune skin blistering disease (AIBD) has an estimated annual incidence of 2.4 to 42.8 new cases per million in different populations, designating it an orphan disease. Characterized by disruption of the skin barrier combined with therapy-induced immunosuppression, BP could pose a risk for skin and soft tissue infections (SSTI). Necrotizing fasciitis (NF) is a rare necrotizing skin and soft tissue infection, with a prevalence of 0.40 cases per 100,000 to 15.5 cases per 100,000 population, often associated with immunosuppression. Low incidences of NF and BP classify them both as rare diseases, possibly contributing to the false inability of making a significant correlation between the two. Here, we present a systematic review of the existing literature related to the ways these two diseases correlate. Materials and methods: This systematic review was conducted according to the PRISMA guidelines. The literature review was conducted using PubMed (MEDLINE), Google Scholar, and SCOPUS databases. The primary outcome was prevalence of NF in BP patients, while the secondary outcome was prevalence and mortality of SSTI in BP patients. Due to the scarcity of data, case reports were also included. Results: A total of 13 studies were included, six case reports of BP complicated by NF with six retrospective studies and one randomized multicenter trial of SSTIs in BP patients. Conclusions: Loss of skin integrity, immunosuppressive therapy, and comorbidities commonly related to BP patients are risk factors for necrotizing fasciitis. Evidence of their significant correlation is emerging, and further studies are deemed necessary for the development of BP-specific diagnostic and treatment protocols.<\/jats:p>","DOI":"10.3390\/medicina59040745","type":"journal-article","created":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T02:02:33Z","timestamp":1681178553000},"page":"745","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Necrotizing Fasciitis\u2014Severe Complication of Bullous Pemphigoid: A Systematic Review, Risk Factors, and Treatment Challenges"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4545-4335","authenticated-orcid":false,"given":"Milan","family":"Stoji\u010di\u0107","sequence":"first","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3209-5214","authenticated-orcid":false,"given":"Milana","family":"Juri\u0161i\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7885-467X","authenticated-orcid":false,"given":"Milana","family":"Marinkovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miodrag","family":"Karamarkovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milan","family":"Jovanovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8297-0243","authenticated-orcid":false,"given":"Jelena","family":"Jeremi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Jovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2168-5400","authenticated-orcid":false,"given":"Aleksandar","family":"Vlahovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Institute for Mother and Child Health Care of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mladen","family":"Jovanovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Plastic and Reconstructive Surgery, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia"},{"name":"Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Radenovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikola","family":"Jovi\u0107evi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dolika","family":"Vasovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Eye Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"a180","DOI":"10.1136\/bmj.a180","article-title":"Bullous pemphigoid and pemphigus vulgaris--incidence and mortality in the UK: Population based cohort study","volume":"337","author":"Langan","year":"2008","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1111\/ddg.13081","article-title":"Incidence of autoimmune bullous diseases in Serbia: A 20-year retrospective study","volume":"14","author":"Medenica","year":"2016","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1038\/jid.2012.35","article-title":"Incidence and Mortality of Bullous Pemphigoid in France","volume":"132","author":"Joly","year":"2012","journal-title":"J. Investig. Dermatol."},{"key":"ref_4","first-page":"434","article-title":"Prospective analysis of the incidence of autoimmune bullous disorders in Lower Franconia, Germany","volume":"7","author":"Bertram","year":"2009","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1111\/j.1365-2133.2009.09300.x","article-title":"Incidence of bullous pemphigoid and pemphigus in Switzerland: A 2-year prospective study","volume":"161","author":"Marazza","year":"2009","journal-title":"Br. J. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1146\/annurev-pathol-012615-044313","article-title":"Mechanisms of Disease: Pemphigus and Bullous Pemphigoid","volume":"11","author":"Hammers","year":"2016","journal-title":"Annu. Rev. Pathol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"D\u2019Agostino, G.M., Rizzetto, G., Marani, A., Marasca, S., Candelora, M., Gambini, D., Gioacchini, H., De Simoni, E., Maurizi, A., and Campanati, A. (2022). Bullous pemphygoid and novel therapeutic approaches. Biomedicines, 10.","DOI":"10.3390\/biomedicines10112844"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1111\/bjd.20743","article-title":"The global incidence of bullous pemphigoid: A systematic review and meta-analysis","volume":"186","author":"Persson","year":"2022","journal-title":"Br. J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jdermsci.2017.11.014","article-title":"Association of HLA class I and class II alleles with bullous pemphigoid in Chinese Hans","volume":"89","author":"Fang","year":"2018","journal-title":"J. Dermatol. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1111\/jdv.12366","article-title":"Drug-induced pemphigoid: A review of the literature","volume":"8","author":"Stavropoulos","year":"2014","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/1346-8138.13031","article-title":"Role of physical factors in the pathogenesis of bullous pemphigoid: Case report series and a comprehensive review of the published work","volume":"43","author":"Chiorean","year":"2016","journal-title":"J. Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100014","DOI":"10.1016\/j.jtauto.2019.100014","article-title":"The pathogenesis of bullous skin diseases","volume":"2","author":"Yang","year":"2019","journal-title":"J. Transl. Autoimmun."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Moro, F., Fania, L., Sinagra, J.L.M., Salemme, A., and Di Zenzo, G. (2020). Bullous pemphigoid: Trigger and predisposing factors. Biomolecules, 10.","DOI":"10.3390\/biom10101432"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"107","DOI":"10.2991\/jegh.k.191028.001","article-title":"Epidemiology of Type 2 Diabetes\u2014Global Burden of Disease and Forecasted Trends","volume":"10","author":"Khan","year":"2020","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1001\/jamadermatol.2018.4556","article-title":"Association of Dipeptidyl Peptidase 4 Inhibitor Use with Risk of Bullous Pemphigoid in Patients with Diabetes","volume":"155","author":"Lee","year":"2019","journal-title":"JAMA Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/j.jaci.2021.06.026","article-title":"Subepidermal blistering eruptions, including bullous pemphigoid, following COVID-19 vaccination","volume":"148","author":"Tomayko","year":"2021","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jaad.2021.03.092","article-title":"Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases","volume":"85","author":"McMahon","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chu, K.Y., Yu, H.S., and Yu, S. (2022). Current and innovated managements for autoimmune bullous skin disorders: An overview. J. Clin. Med., 11.","DOI":"10.3390\/jcm11123528"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/S0002-9343(97)00160-5","article-title":"Population-Based Surveillance for Group a Streptococcal Necrotizing Fasciitis: Clinical Features, Prognostic Indicators, and Microbiologic Analysis of Seventy-Seven Cases","volume":"103","author":"Kaul","year":"1997","journal-title":"Am. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2147\/IJGM.S82999","article-title":"Necrotizing fasciitis: Epidemiology and clinical predictors for amputation","volume":"14","author":"Tantraworasin","year":"2015","journal-title":"Int. J. Gen. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sablone, S., Lagouvardou, E., Cazzato, G., Carravetta, F., Maselli, R., and Merlanti, F. (2022). Necrotizing fasciitis of the thigh as unusual colonoscopic polypectomy complication: Review of the literature with case presentation. Medicina, 58.","DOI":"10.3390\/medicina58010131"},{"key":"ref_22","first-page":"981","article-title":"Necrotizing fasciitis","volume":"55","author":"Puvanendran","year":"2009","journal-title":"Can. Fam. Physician."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.2106\/00004623-200308000-00005","article-title":"Necrotizing fasciitis: Clinical presentation, microbiology, and determinants of mortality","volume":"85","author":"Wong","year":"2003","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.idc.2020.10.004","article-title":"Necrotizing Soft Tissue Infections","volume":"35","author":"Stevens","year":"2021","journal-title":"Infect. Dis. Clin. North Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1056\/NEJMra1600673","article-title":"Necrotizing Soft-Tissue Infections","volume":"377","author":"Stevens","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_28","unstructured":"Aromataris, E., and Munn, Z. (2020). JBI Manual for Evidence Synthesis., Available online: https:\/\/synthesismanual.jbi.global."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1046\/j.1365-2230.2003.01285_2.x","article-title":"Bullous pemphigoid complicated by nonfatal necrotizing fasciitis","volume":"28","author":"Chamberlain","year":"2003","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.annder.2010.03.015","article-title":"Cutaneous infections in bullous pemphigoid patients treated with topical corticosteroids","volume":"137","author":"Boughrara","year":"2010","journal-title":"Ann. Dermatol. Venereol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.revmed.2011.03.208","article-title":"Purpura r\u00e9tiforme et pemphigo\u00efde bulleuse: Une association fatale?","volume":"32","author":"Longueville","year":"2011","journal-title":"Rev. Med. Interne"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"252","DOI":"10.3109\/15569527.2012.751391","article-title":"Necrotizing fasciitis in a patient with bullous pemphigoid treating with systemic steroid","volume":"32","author":"Ekiz","year":"2013","journal-title":"Cutan. Ocul. Toxicol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e236","DOI":"10.1111\/ijd.12023","article-title":"Early necrotizing fasciitis following initiation of mycophenolate mofetil in two patients with bullous pemphigoid","volume":"53","author":"Regnier","year":"2014","journal-title":"Int. J. Dermatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e313","DOI":"10.1111\/ajd.12859","article-title":"Bullous pemphigoid complicated by necrotising fasciitis successfully treated with systemic corticosteroids and antibiotics in combination with i.v. immunoglobulin","volume":"59","author":"Noguchi","year":"2018","journal-title":"Australas J. Dermatol."},{"key":"ref_35","unstructured":"Juri\u0161i\u0107, M., Nikoli\u0107, G., Nikoli\u0107 \u017divanovi\u0107, M., and Stoji\u010di\u0107, M. (2023). Necrotizing fasciitis-a complication of autoimmune skin blistering diseases? Case report and literature review. J. Infect. Dev. Ctries, (in press)."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1056\/NEJMoa011592","article-title":"A Comparison of Oral and Topical Corticosteroids in Patients with Bullous Pemphigoid","volume":"346","author":"Joly","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1111\/1346-8138.12175","article-title":"Infection in autoimmune bullous diseases: A retrospective comparative study","volume":"40","author":"Lehman","year":"2013","journal-title":"J. Dermatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1111\/bjd.12806","article-title":"Mortality of bullous pemphigoid in Singapore: Risk factors and causes of death in 359 patients seen at the National Skin Centre","volume":"170","author":"Cai","year":"2014","journal-title":"Br. J. Dermatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/j.jaad.2015.01.029","article-title":"Infectious complications in bullous pemphigoid: An analysis of risk factors","volume":"72","author":"Phoon","year":"2015","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1111\/bjd.14821","article-title":"Hospitalization, inpatient burden and comorbidities associated with bullous pemphigoid in the U.S.A","volume":"176","author":"Ren","year":"2017","journal-title":"Br. J. Dermatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.3389\/fimmu.2020.01607","article-title":"Assessment of the Characteristics and Associated Factors of Infectious Complications in Bullous Pemphigoid","volume":"11","author":"Chen","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/00000372-198100320-00002","article-title":"A preliminary communication on extensively disseminated Kaposi\u2019s sarcoma in young homosexual men","volume":"3","author":"Gottlieb","year":"1981","journal-title":"Am. J. Dermatopathol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.1056\/NEJMc0708819","article-title":"Propranolol for severe hemangiomas of infancy","volume":"358","author":"Hubiche","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1111\/jdv.12065","article-title":"Mortality of bullous pemphigoid in the first year after diagnosis: A retrospective study in a Spanish medical centre","volume":"28","author":"Gual","year":"2014","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1111\/jdv.14961","article-title":"Association of serious infections with pemphigus and pemphigoid: Analysis of the Nationwide Inpatient Sample","volume":"32","author":"Ren","year":"2018","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/ijd.12243","article-title":"Specific causes of death in patients with bullous pemphigoid as measured by death certificate data: A retrospective cohort study","volume":"54","author":"Barrick","year":"2015","journal-title":"Int. J. Dermatol."},{"key":"ref_47","first-page":"474","article-title":"Skin and Soft Tissue Infections","volume":"92","author":"Ramakrishnan","year":"2015","journal-title":"Am. Fam. Physician"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.autrev.2005.05.006","article-title":"Rituximab: A promising therapy in systemic lupus erythematosus","volume":"5","author":"Thatayatikom","year":"2006","journal-title":"Autoimmun. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2580","DOI":"10.1002\/art.20430","article-title":"B cell depletion as a novel treatment for systemic lupus erythematosus: A phase I\/II dose-escalation trial of rituximab","volume":"50","author":"Looney","year":"2004","journal-title":"Arthritis. Rheum."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/6971027","article-title":"A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature","volume":"2017","author":"Abdulkareem","year":"2017","journal-title":"Case. Rep. Hematol."},{"key":"ref_51","first-page":"331","article-title":"Management of massive soft tissue defects: The use of INTEGRA\u00ae artificial skin after necrotizing soft tissue infection of the chest","volume":"4","author":"Rashid","year":"2012","journal-title":"J. Thorac. Dis"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1001\/jamasurg.2013.173","article-title":"Immunocompromised Status in Patients with Necrotizing Soft-Tissue Infection","volume":"148","author":"Keung","year":"2013","journal-title":"JAMA Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1365-2133.1975.tb06488.x","article-title":"Immunosuppression and skin infection","volume":"93","author":"Savin","year":"1975","journal-title":"Br. J. Dermatol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1002\/art.1780210107","article-title":"Computer analysis of factors influencing frequency of infection in systemic lupus erythematosus","volume":"21","author":"Ginzler","year":"1978","journal-title":"Arthritis Rheum."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1093\/clinids\/11.6.954","article-title":"Risk of Infectious Complications in Patients Taking Glucocorticosteroids","volume":"11","author":"Stuck","year":"1989","journal-title":"Clin. Infect. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1001\/archderm.138.7.903","article-title":"Risk Factors for Lethal Outcome in Patients with Bullous Pemphigoid","volume":"138","author":"Rzany","year":"2002","journal-title":"Arch. Dermatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1128\/microbiolspec.DMIH2-0026-2016","article-title":"Overview of Infections in the Immunocompromised Host","volume":"4","author":"Dropulic","year":"2016","journal-title":"Microbiol. Spectr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.jaad.2019.03.049","article-title":"Rituximab therapy in patients with bullous pemphigoid: A retrospective study of 20 patients","volume":"81","author":"Polansky","year":"2019","journal-title":"J. Am. Acad. Dermatol"},{"key":"ref_59","first-page":"9","article-title":"Effectiveness and Safety of Rituximab in Recalcitrant Pemphigoid Diseases","volume":"19","author":"Lamberts","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e119-25","DOI":"10.1002\/bjs.9371","article-title":"Early diagnosis of necrotizing fasciitis","volume":"101","author":"Goh","year":"2013","journal-title":"Br. J. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0094-1298(02)00066-4","article-title":"Wound healing and diabetes mellitus","volume":"30","author":"Greenhalgh","year":"2003","journal-title":"Clin. Plast. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"358","DOI":"10.4158\/EP.12.4.358","article-title":"Prevalence and Predictors of Corticosteroid-Related Hyperglycemia in Hospitalized Patients","volume":"12","author":"Donihi","year":"2006","journal-title":"Endocr. Pract."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1007\/s00125-010-1672-5","article-title":"Skin and soft tissue infections in hospitalised patients with diabetes: Culture isolates and risk factors associated with mortality, length of stay and cost","volume":"53","author":"Lipsky","year":"2010","journal-title":"Diabetologia"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1111\/j.1365-2133.2011.10386.x","article-title":"Comorbidity profiles among patients with bullous pemphigoid: A nationwide population-based study","volume":"165","author":"Chen","year":"2011","journal-title":"Br. J. Dermatol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"36","DOI":"10.3389\/fsurg.2014.00036","article-title":"Current concepts in the management of necrotizing fasciitis","volume":"1","author":"Misiakos","year":"2014","journal-title":"Front. Surg."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1086\/511638","article-title":"Necrotizing Soft-Tissue Infection: Diagnosis and Management","volume":"44","author":"Goldstein","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1191\/0961203306lu2314cr","article-title":"Necrotizing fasciitis in rheumatic diseases","volume":"15","author":"Mok","year":"2006","journal-title":"Lupus"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1749-7922-6-46","article-title":"Necrotizing fasciitis: Literature review of contemporary strategies for diagnosing and management with three case reports: Torso, abdominal wall, upper and lower limbs","volume":"6","author":"Roje","year":"2011","journal-title":"World J. Emerg. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Chen, H.-Y., Huang, T.-Y., Chen, J.-L., Kuo, L.-T., Huang, K.-C., and Tsai, Y.-H. (2022). Rational use of ceftriaxone in necrotizing fasciitis and mortality associated with bloodstream infection and hemorrhagic bullous lesions. Antibiotics, 111.","DOI":"10.3390\/antibiotics11111454"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1097\/01.CCM.0000129486.35458.7D","article-title":"The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections","volume":"32","author":"Wong","year":"2004","journal-title":"Crit. Care Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1308\/rcsann.2017.0053","article-title":"Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: A systematic review of the literature","volume":"99","author":"Bechar","year":"2017","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.bjps.2008.07.031","article-title":"Abdominoplasty as a reconstructive surgical treatment of necrotising fasciitis of the abdominal wall","volume":"62","author":"Brafa","year":"2009","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1016\/j.burns.2021.01.005","article-title":"Flap coverage for necrotising soft tissue infections: A systematic review","volume":"47","author":"Somasundaram","year":"2021","journal-title":"Burns"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Tian, Y., Liu, T., Zhao, Cq., Lei, Y.-Z., Fan, D.-L., and Mao, T-Ch. (2018). Negative pressure wound therapy and split thickness skin graft aided in the healing of extensive perineum necrotizing fasciitis without faecal diversion: A case report. BMC Surg., 18.","DOI":"10.1186\/s12893-018-0411-6"},{"key":"ref_75","first-page":"675","article-title":"Bullous pemphigoid appearing both on thermal burn scars and split-thickness skin graft donor sites","volume":"11","author":"Neri","year":"2013","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/j.1365-2230.1991.tb00306.x","article-title":"Split skin grafting and bullous pemphigoid","volume":"16","author":"McGrath","year":"1991","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_77","first-page":"40","article-title":"Blistering on a squamous cell carcinoma graft site in a patient with bullous pemphigoid","volume":"54","author":"Levin","year":"1994","journal-title":"Cutis"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1054\/bjps.2001.3601","article-title":"Development of a bullous pemphigoid after split-skin grafting","volume":"54","author":"Ghura","year":"2001","journal-title":"Br. J. Plast. Surg."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.1365-2230.2004.01689.x","article-title":"Localized bullous pemphigoid 20 years after split skin grafting","volume":"30","author":"Hafejee","year":"2005","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1067\/mjd.2001.116337","article-title":"Intravenous immunoglobulin therapy for patients with bullous pemphigoid unresponsive to conventional immunosuppressive treatment","volume":"45","author":"Razzaque","year":"2001","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jdermsci.2016.11.003","article-title":"A randomized double-blind trial of intravenous immunoglobulin for bullous pemphigoid","volume":"85","author":"Amagai","year":"2017","journal-title":"J. Dermatol. Sci."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1086\/376630","article-title":"The Streptlg Study Group, Intravenous Immunoglobulin G Therapy in Streptococcal Toxic Shock Syndrome: A European Randomized, Double-Blind, Placebo-Controlled Trial","volume":"37","author":"Darenberg","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1093\/cid\/ciy401","article-title":"Polyspecific Intravenous Immunoglobulin in Clindamycin-treated PAients With Streptococcal Toxic Shock Syndrome: A Systematic Review and Meta-analysis","volume":"67","author":"Parks","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"3440","DOI":"10.1172\/JCI24394","article-title":"Complete FcRn dependence for intravenous Ig therapy in autoimmune skin blistering diseases","volume":"115","author":"Li","year":"2005","journal-title":"J. Clin. Investig."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.3389\/fimmu.2019.01090","article-title":"High-dose intravenous immunoglobulin in skin autoimmune disease","volume":"10","author":"Hoffmann","year":"2019","journal-title":"Front. Immunol."},{"key":"ref_86","first-page":"1002","article-title":"Necrotizing Soft Tissue Infection in a Patient with Bullous Systemic Lupus Erythematosus: Case Report","volume":"1","author":"Leo","year":"2018","journal-title":"Ann. Arthritis Clin. Rheumatol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"3525","DOI":"10.1038\/s41598-019-40203-7","article-title":"B-cell depletion induces a shift in self antigen specific B-cell repertoire and cytokine pattern in patients with bullous pemphigoid","volume":"9","author":"Berkani","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"191","DOI":"10.2340\/00015555-2101","article-title":"Enzyme-linked immunoassay index for anti-NC16a IgG and IgE auto-antibodies correlates with severity and activity of bullous pemphigoid","volume":"96","author":"Kalowska","year":"2016","journal-title":"Acta Derm. Venereol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"S98","DOI":"10.1016\/j.jid.2019.03.646","article-title":"570 Safety and efficacy of bertilimumab, a human anti-eotaxin-1 monoclonal antibody, in bullous pemphigoid in a phase 2a study","volume":"139","author":"Fiorino","year":"2019","journal-title":"J. Investig. Dermatol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"e000008","DOI":"10.1136\/lupus-2014-000008","article-title":"Necrotising fasciitis in systemic lupus erythematosus: A case report and literature review","volume":"1","author":"Tung","year":"2014","journal-title":"Lupus Sci. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/4\/745\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:13:36Z","timestamp":1760123616000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/4\/745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,11]]},"references-count":90,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["medicina59040745"],"URL":"https:\/\/doi.org\/10.3390\/medicina59040745","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,11]]}}}