Authors: Camille Joyce J. Crisostomo, MD, Lalaine R. Visitacion, MD, FPDS


Introduction: Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease, typically occuring in the elderly. It is due to autoantibodies against basement membrane antigens BP230 and BP180. The classic form of BP presents as tense blisters on normal or erythematous skin found on the flexures, abdomen and thighs. However, unusual presentations may predominate, including localized BP, erythroderma, and prurigo nodularis-like lesions. Dyshidrosiform pemphigoid is an unusual variant of localized BP presenting as vesicobullous eruptions on palms and/or soles, resembling pompholyx or bullous tinea pedis. These atypical presentations may conceal BP, persist for years, or may eventually evolve into generalized BP. We present a case of a 92 year-old-male who initially presented with bullae on hands and feet, which eventually involved the trunk and extremities.

Case Summary: A 92 year-old male presented with a 2-week history of tense, pruritic, clear fluid-filled vesicles and bullae on hands and feet. Impression was Dyshidrotic Dermatitis. During the course of hospital stay, new vesicles and bullae on an erythematous base were noted on the trunk and extremities. Skin punch biopsy revealed epidermal atrphy and dermal edema with infiltrates of neutrophils and eosinophils with few eosinophils in between adipose lobules. This was highly suggestive of BP. Direct immunofluorescence was negative on the perilesional specimen taken from the lower extremity. Management consisted only of topical steroids and antibiotics, affording improvement.

Conclusion: Dyshidrosiform pemphigoid can present as vesicles and bullae on hands and feet mimicking dyshidrotic dermatitis. This unusual condition can eventually evolve to classic bullous pemphigoid.





Bullous pemphigoid, BP



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