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Localized bullous pemphigoid: a case report.

Yiman Wang¹, Xuming Mao², Yangchun Liu¹

¹Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.

Annals of Translational Medicine

|April 21, 2020

Summary

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Localized bullous pemphigoid (BP) in a young adult, presenting as itchy erythema, was successfully treated with minocycline and nicotinamide. This rare condition, often misdiagnosed, highlights the need for awareness and potential long-term monitoring.

Area of Science:

Dermatology
Autoimmunology

Background:

Bullous pemphigoid (BP) is typically an autoimmune blistering disease affecting the elderly, characterized by autoantibodies against basement membrane components.
Localized forms of BP, especially in young adults, are rare, with limited understanding and potential for misdiagnosis.

Observation:

A 30-year-old woman presented with a 4-month history of itchy, well-demarcated erythema and maculopapules on her trunk, initially misdiagnosed as contact dermatitis.
The lesions exhibited characteristics of localized bullous pemphigoid, including serum autoantibodies to BP antigen 180 (BP180), subepidermal blistering with eosinophilic and neutrophilic infiltration, and linear IgG deposition at the dermoepidermal junction.

Findings:

Histopathological examination confirmed a subepidermal blister with significant eosinophil and neutrophil infiltration.

Keywords:

Bullous pemphigoid (BP)case report diagnosis mechanism

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Salt-split indirect immunofluorescence demonstrated linear IgG deposition along the dermoepidermal junction, consistent with bullous pemphigoid.

Treatment with oral minocycline (200 mg/day) and nicotinamide (1,500 mg/day) resulted in complete resolution of lesions within one month.

Implications:

Localized bullous pemphigoid can present atypically and is frequently misdiagnosed, necessitating a high index of suspicion.
While this localized form appears to have a more benign course, long-term follow-up is crucial due to the risk of progression to generalized bullous pemphigoid.
This case underscores the potential efficacy of minocycline and nicotinamide in managing localized bullous pemphigoid.