Bullous scabies mimicking bullous pemphigoid

Scabies is an infestation caused by Sarcoptes scabiei and characterised by polymorphous lesions that may include burrows, papules, nodules, excoriation and crusts. Vesicular and bullous lesions are rather rare. Several diseases may be confused with scabies. We report a case of bullous scabies which, on the basis of the clinical and histopathological picture, mimicked bullous pemphigoid. Direct and indirect immunofluorescence were negative. Bullae recurred and persisted despite systemic corticosteroids. The patient was successfully treated with 5% permethrin and remained disease free for up to 12 months of follow-up.     

A dilemma: bullous-pemphigoid-like eruption in scabies or scabies-induced bullous pemphigoid

Several diseases may be confused with scabies. Atypical manifestations of scabies have previously been reported, including urticaria, contact dermatitis, and dermatitis herpetiformis. There are also reports of scabies mimicking bullous pemphigoid. Here we report a case of scabies in a patient with manifestation similar to bullous pemphigoid. Direct smear of the bullous lesions was performed and was positive for scabies mites. The skin biopsy specimens submitted for light microscopy and direct immunofluorescence study were considered to be compatible with bullous pemphigoid. The patient treated with single dose oral ivermectin and prednisolone. The pruritus subsided and the eruption improved dramatically in 2 weeks.     

Bullous pemphigoid and psoriasis: does subclinical bullous pemphigoid exist?

Four cases are presented in which probable bullous pemphigoid and probable psoriasis co-existed. One case represents a simple coincidence ofthe two diseases. In the other three cases, the bullous lesions were transient and seemed to be induced by elements ofthe Gocckerman regimen. The hypothesis is presented that these three cases represent a subclinical form of bullous pempbigoid induced by the irritant effects of coal tar, ultraviolet light, the reduced barrier function ofa pre-existing derma-tosis, or a combination of these factors.     

Bullous pemphigoid associated with silicosis

Bullous pemphigoid (BP) has never before been reported to associate with silicosis, although there are numerous reports of silicosis accompanied by different autoimmune diseases, such as systemic sclerosis, systemic lupus erythematosus, dermatomyositis or rheumatoid arthritis. We report on a 63-year-old Japanese patient with silicosis who developed tensed bullae, erosions and macular pigmentation on the trunk and extremities. Indirect immunofluorescence revealed anti-basement-membrane-zone antibodies; immunoblotting analysis demonstrated that the patient's serum reacted with the 230-kD BP antigen in the epidermal extracts, as well as a recombinant protein of the NC16a domain of 180-kD BP antigen. Clinical symptoms improved after treatment with systemic steroids. To the best of our knowledge, this is the first reported case of BP associated with silicosis.     

Bullous pemphigoid: associated diseases

Bullous pemphigoid is a fairly common chronic disease of elderly persons, many of whom have other medical conditions and problems. In the main, a search for commonly associated diseases is not warranted.     

Bullous pemphigoid associated with acute glomerulonephritis

We report an 82-year-old man who presented with bullous pemphigoid and who later developed an acute glomerulonephritis with the histopathological and immunofluorescence pattern of a postinfectious glomerulonephritis. Antibodies directed against 230 and 180 kDa bullous pemphigoid antigens were detected in the patient's serum by means of the immunoprecipitation technique. Staphylococcus aureus and methicillin-resistant S. aureus were isolated from the patient's skin. We consider that in this particular patient the cutaneous infection played a part in the development of the kidney complication.     

Bullous pemphigoid associated with prostate adenocarcinoma

Bullous pemphigoid is a common autoimmune skin disease characterized by the presence of subepidermal blisters. It has been associated with underlying neoplasia in isolated reports. A 78-year-old man with generalized blisters was diagnosed as bullous pemphigoid on clinical, histopathological and direct immunofluorescence grounds. His free and total prostate specific antigen (PSA) levels were high and histopathological examination of a prostate specimen revealed prostate adenocarcinoma. We present this rare case to discuss the possible association between bullous pemphigoid and prostate adenocarcinoma.     

Trichophytic granuloma associated with bullous pemphigoid

A 69-year-old Japanese man developed multiple nodular granulomatous cutaneous lesions caused by Trichophyton rubrum during treatment of bullous pemphigoid. One and a half months after the initiation of oral corticosteroid therapy, the lesions appeared. He had suffered from tinea pedis for several decades. Oral ketoconazole was given for 6 weeks with remarkable improvement. Trichophytic granuloma is a rare but important complication of bullous pemphigoid.     

Kaposi's sarcoma associated with immunosuppression for bullous pemphigoid

Kaposi's sarcoma may occur in transplant recipients on immunosuppressive regimens, but is not well recognized in association with treatment for dermatological disease. We report two cases where multifocal Kaposi's sarcoma developed following iatrogenic immunosuppression with prednisolone and azathioprine for bullous pemphigoid. Both patients were HIV negative and, in one case, lesions regressed both clinically and histologically when immunosuppressive therapy was withdrawn.