Hrev_master


Mosquito net as an 
environmental aid in the 
management of pemphigus
Ghazal Ahmed
Department of Dermatology,
Venereology, and Leprosy, All India
Institute of Medical Sciences, Raipur,
India

Dear Editor
Pemphigus is often difficult to manage

disease, which involves, apart from the
pharmacological management, maintaining
the environmental temperature and humidi-
ty within a narrow range as the loss of skin
easily result in thermal and hydration
imbalance.1 While this might be easy to do
this in a well-equipped hospital with air-
conditioning, but turns out to be difficult in
a low resource set-up.

In this context, mosquito nets may play
an adjunctive role. Using a mosquito net
with appropriate coverage on the sides,
keeping the upper surface open can help
create a personal niche for the patient. It
keeps the micro-environment around the
patient warm and comfortable and can even
possibly prevent fluid loss from extensive
erosions as it is well-known for attenuating
the airflow.2 Very often, patients with exten-

sive erosions need open dressing with min-
imal clothing for faster healing.
Nevertheless, the privacy of the patient
should be regarded as right and respected.3
The mosquito net-based set-up provides a
private space for the patient to avoid unnec-
essary anxiety of nakedness. While there
might be some alternative to the mosquito
net, we have used the net considering the
wide availability, cheap, and even cus-
tomizable. There is limited or no data avail-
able on the ideal micro-environment for
pemphigus treatment. The pemphigus
resembles burn patients in terms of skin loss
and evaporative loss. The recommended
temperature of 32-35 degrees Celsius with a
relative humidity of 50% for burn patient
management to reduce the evaporative loss4
might be applied to the pemphigus manage-
ment. Airflow around the burn patient is
also advocated in burn patients in the expo-
sure method. However, mosquito net mesh
size is found to be inversely related to air-
flow. To overcome this problem, we have
covered the sides of the net with cloths and
kept the top uncovered. The mosquito net
can also be stitched in a customized way
using smaller mesh sides but having a more
oversized mesh top. A ceiling fan can be
placed just above the net. Temperature is
also another critical factor,5 and in the win-
ter or colder places will need attention. We
have used a 100–200-Watt tungsten fila-

ment bulb on the open side if needed to add
heat. However, other external heating
sources can also be used. Nevertheless, we
will require clinical studies to evaluate the
system objectively and in the clinical out-
come context.

References
1. Kar PK. Recent trends in the manage-

ment of pemphigus vulgaris. Med J
Armed Forces India 1998;54:243-6. 

2. von Seidlein L, Ikonomidis K, Bruun R,
et al. Airflow attenuation and bed net
utilization: observations from Africa
and Asia. Malar J 2012;11:200. 

3. Lindsay E, Renyi R, Wilkie P, et al.
Patient-centred care: a call to action for
wound management. J Wound Care
2017;26:662-77. 

4. Martin CJ, Ferguson JC, Rayner C.
Environmental conditions for treatment
of burned patients by the exposure
method. Burns 1992;18:273-82. 

5. Alonso Fernández JM, López Pablo C.
Body temperature and heating tempera-
ture in the care of large burn patients.
Global Nursing 2021;20:466–88. 

                                     Healthcare in Low-resource Settings 2022; volume 10:9828

Correspondence: Ghazal Ahmed, Department
of Dermatology, Venereology, and Leprosy,
Block-D, First Floor, All India Institute of
Medical Sciences, PIN 492099, Raipur, India. 
Tel.: +91.9835521686.
E-mail: ghazal.ahmed4u@gmail.com 

Key words: Bullous disease; pemphigus; body
temperature regulation; moisture.

Conflict of interests: The author declares no
conflict of interest.

Availability of data and materials: All data
underlying the findings are fully available.

Received for publication: 24 April 2021.
Revision received: 24 August 2021.
Accepted for publication: 13 December 2021.

This work is licensed under a Creative
Commons Attribution 4.0 License (by-nc 4.0).

©Copyright: the Author(s), 2022
Licensee PAGEPress, Italy
Healthcare in Low-resource Settings 2022; 10:9828
doi:10.4081/hls.2022.9828

Figure 1. Showing a patient inside a mosquito net with bedsheets hanging from sides and
an incandescent bulb. In this picture, bedsheets were folded up to show the set-up. 

                                                             [Healthcare in Low-resource Settings 2022; 10:9828]                                            [page 13]

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