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Bullous pemphigoid presenting as exfoliative erythroderma
J Alonso-Llamazares1, S M Dietrich, L E Gibson
1Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Journal of the American Academy of Dermatology
|November 12, 1998
Summary
This study reports a rare case of bullous pemphigoid presenting as exfoliative erythroderma without blisters. Diagnosis was confirmed via skin biopsy and antibody testing, highlighting an unusual presentation of this autoimmune blistering disease.
Area of Science:
- Dermatology
- Immunodermatology
- Pathology
Background:
- Bullous pemphigoid (BP) typically presents with blisters, but unusual clinical variants exist.
- Exfoliative erythroderma is a generalized scaling condition that can sometimes overlap with other dermatoses.
- Previous reports describe BP in erythroderma patients who develop bullae.
Observation:
- This report details a patient with exfoliative erythroderma who did not exhibit any blistering.
- The clinical presentation mimicked generalized erythroderma without the characteristic bullae of BP.
- Diagnosis of bullous pemphigoid was established despite the absence of visible blisters.
Findings:
- Skin biopsy revealed eosinophilic spongiosis, a key histopathological feature.
- Serological tests detected circulating antibodies targeting the basement membrane zone.
- Immunofluorescence on salt-split skin showed an epidermal pattern of antibody deposition, consistent with BP.
Implications:
- This case expands the spectrum of clinical presentations for bullous pemphigoid.
- It underscores the importance of histopathological and immunopathological examination in diagnosing atypical dermatological conditions.
- Early recognition of such variants is crucial for timely and appropriate management of bullous pemphigoid.