Extensive milia formation in a young woman with bullous pemphigoid

Sir, Bullous pemphigoid is the most common subepidermal immunobullous disorder that usually affects the elderly population.1 It is characterized clinically by the presence of tense blisters either on erythematous/urticated base or on normal‐looking skin, and immunopathologically by linear deposition of immunoglobulin G and complement fraction 3 (C3) along the dermoepidermal junction. Indirect immunofluorescence microscopy on salt‐split skin further helps confirm the diagnosis and typically shows immunoglobulin G staining on the epidermal side of the split (“roof‐binding” pattern).1 Autoantibodies in bullous pemphigoid are directed against the hemidesmosomal proteins – bullous pemphigoid antigen 180 and bullous pemphigoid antigen 230. It may at times be difficult to distinguish bullous pemphigoid from other subepidermal immunobullous diseases, especially epidermolysis bullosa acquisita. Younger age group, acral blistering, absence of family history, scarring and milia formation are often used as clinical criteria to differentiate epidermolysis bullosa acquisita from bullous pemphigoid.2 Here, we report the case of a young woman with bullous pemphigoid, who uncharacteristically developed extensive milia during the recovery phase.