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Dr Arndt apparently misinterpreted our statement that "similar blisters of the skin have not been described in comatose patients unrelated to drug overdose." In the context of our article, "similar blister" is defined as blisters with histologically demonstrated underlying sweat gland necrosis. "Comatose patients unrelated to drug overdose" excludes patients with carbon monoxide poisoning and includes only patients who are comatose secondary to a neurologic disease and who are not being treated with drugs. We stated in our introduction that blisters with sweat gland necrosis were reported in cases of carbon monoxide poisoning and provided a reference to a description that may be more complete than the report by Napoleon's surgeon.The review by Arndt et al failed to demonstrate the presence of sweat gland necrosis in patients in coma secondary to neurologic disease in whom bullous lesions developed. Since histopathologic studies were not performed in the cases cited
Herschthal D, Robinson MJ. Bullae in Comatose Patients-Reply. Arch Dermatol. 1980;116(1):19. doi:10.1001/archderm.1980.01640250021004
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