Severe bullous pemphigoid with excoriation disorder

Area of Science:

• Dermatology
• Immunology
• Psychiatry

Background:

• Bullous pemphigoid is the most common autoimmune blistering skin disease.
• Its pathogenesis involves autoantibodies targeting the basement membrane, leading to blisters and pruritus.
• Concurrent excoriation disorder presents a complex clinical challenge.

Purpose of the Study:

• To report a unique case of bullous pemphigoid with a concurrent excoriation disorder.
• To detail the diagnostic and therapeutic approach for this complex presentation.
• To emphasize the interplay between dermatological and psychiatric conditions.

Main Methods:

• Diagnosis of bullous pemphigoid confirmed via direct immunofluorescence testing on punch biopsy.
• Treatment included vancomycin and steroids for bullous pemphigoid.
• Excoriation disorder managed with cross-tapering from duloxetine to fluoxetine.

Main Results:

• Successful confirmation and treatment of bullous pemphigoid.
• Effective management of the concurrent excoriation disorder.
• Demonstration of a unique case with both dermatological and psychiatric comorbidities.

Conclusions:

• This case underscores the importance of considering psychiatric comorbidities in complex dermatological conditions.
• Integrated treatment approaches are crucial for managing patients with co-existing bullous pemphigoid and excoriation disorder.
• The successful management highlights the potential for combined dermatological and psychiatric interventions.