We describe three patients with bullous pemphigoid who presented with bullae at sites of trauma and with little spread of the condition outside such areas. The diagnosis was confirmed by histology and direct and/or indirect immunofluorescence; electron microscopy was performed in two cases to rule out the diagnosis of epidermolysis bullosa acquisita (EBA). Treatment was with either systemic steroids or ACTH in all three cases. Trauma-induced bullous pemphigoid should be included in the differential diagnosis of localized blistering eruptions. 相似文献
Case 1 An 87‐year‐old man, with a 2‐year history of a generalized exfoliative erythroderma involving approximately 90% of the body, presented with an onset of tense blisters symmetrically distributed on most of his body. Clinical examination revealed generalized erythema, edema, moderate lichenification, and scaling, with several tense and grouped blisters on the hypocondrium, buttocks, left knee, and back of the left hand ( Fig. 1 ). A biopsy specimen, taken from lesional erythematous skin, revealed a dermal–epidermal separation with a mixed inflammatory infiltrate containing numerous eosinophils. Direct immunofluorescence of perilesional skin on the abdomen demonstrated linear deposition of immunoglobulin G (IgG) and C3 at the basement membrane zone (BMZ) ( Fig. 2 ). Indirect immunofluorescence demonstrated serum IgG antibodies directed against BMZ antigens at a titer of 1 : 20. Utilizing salt‐split human skin as a substrate, serum revealed the presence of IgG antibodies that bound to the epidermal side at a titer of 1 : 80. Blotting studies demonstrated circulating IgG antibodies which bound to the 180 kDa bullous pemphigoid (BP) antigen ( Fig. 3 ). Human leukocyte antigen (HLA) typing revealed A3, B41, Cw2, DR4, DR11, DRw53, and DQ3. Figure 1 Open in figure viewer PowerPoint Several small, tense, grouped blisters associated with diffuse erythema and moderate lichenification and scaling localized on the anterior surface of the trunk 相似文献
A 73-year-old women developed tight blisters exclusively on the legs. The histological and immunological examinations substantiated the diagnosis of localized pemphigoid. The disease had a chronic course and responded well to treatment with prednisolone. 相似文献