Dear Editor

Pemphigus is often difficult to manage disease, which involves, apart from the pharmacological management, maintaining the environmental temperature and humidity 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 airconditioning, 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 extensive erosions need open dressing with minimal 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 unnecessary 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 customizable. There is limited or no data available 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 management. Airflow around the burn patient is also advocated in burn patients in the exposure method. However, mosquito net mesh size is found to be inversely related to airflow. 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 winter or colder places will need attention. We have used a 100–200-Watt tungsten filament 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 outcome context.