[A case of dyshidrosiform pemphigoid]

We report a case of dyshydrosiform pemphigoid. Multiple small bullae were noticed in the bilateral hands and feet of an 85 year old Japanese male about 1 month before admission to hospital, and these lesions gradually worsened and expanded generally. Clinical appearance on the initial examination showed a collection of erosions, bullae, and pustules with haemorrhagic pompholyx. Serum anti-BP180 antibody index was more than 150. Histopathologic appearance of the bullous leision revealed a subepidermal bulla with an inflammatory infiltrate and fibrinous exudate, with aggregated eosinophils, neutrophils, and lymphocytes in the upper dermis. In direct immunofluorescence, the epidermal basement membrane was stained strongly for complement C3 and weakly for IgG. Based on these features, especially from the particular clinical aspects, we finally diagnosed one subtype of bullous pemphigoid, namely dyshidrosiform pemphigoid. Although he got better by orally taking steroids, the eruptions recurred just after tapering off. Thereafter, he died due to worsened general condition partly complicated by pancreatitis.