Bullous pemphigoid: three atypical cases.

Sir, NaCl split human skin as substrate showed reactivity of anti-human IgG goat serum on the epidermal side. By Bullous pemphigoid (BP) is a relatively common chronic autoimmune subepidermal blistering disease, which freimmunoblotting on cultured keratinocyte extracts, a 180 kDa BPAG2 antigen was identified in the patient’s quently occurs in the elderly. Typically, patients with BP present with large tense bullae on an erythematous serum. A diagnosis of seborrheic BP was made on the basis base, located at the sides of the neck, axillae, groins, upper inner aspects of the thighs and abdomen. Many of the clinical and laboratory findings. The patient had been taking losartan, 25mg, for hypertension for 6 diVerent clinical variants of BP have been described (1). The main therapy for BP is based on systemic corticoyears. Losartan was withdrawn and deflazacort therapy at 60mg daily was started. After 10 days, the patient steroids and immunosuppressants , but alternative treatments (erythromycin, tetracyclines plus niacinamide, and improved clinically, with no development of new lesions. Two weeks later, with no evidence of any lesions, the topical high-potency steroids) have been reported to be eVective in some cases (1, 2). steroid dosage was gradually tapered and reduced to zero within a month. After 2 months, the patient’s blood We describe three cases of BP that were unusual for clinical presentation, triggering by identiŽ ed factors and pressure rose again and, of his own volition, he restarted losartan treatment (25mg/day). A few days later, erupresponsiveness to non-conventional treatments. tions similar to the previous ones appeared on the same sites. Losartan was finally stopped and replaced with a CASE REPORTS beta-blocker. A topical treatment with clobetasol propionate proved to be sufficient to clear all lesions in a Case 1 couple of weeks. A 59-year-old man presented with bullous eruptions located on his scalp, forehead, and sternal region (seborrheic areas). The tense bullae were 0.5–1 cm in Case 2 size, on a base that appeared erythematous and covered A 76-year-old man with moderate essential hypertension by greasy scaling. The eruption had been present for a was being treated with 10mg enalapril daily for 12 few months (Fig. 1). months when he noticed some yellowish pustules and Histologically, the blisters were subepidermal with a erosions in the perineum and axillae. In time, papildense infiltrate of eosinophils. Direct immunofluoreslomatous proliferations developed at the sites of the cence (IF ) studies revealed linear deposition of IgG and initial pustular lesions and crops of bullae appeared on C3 at the dermo-epidermal junction. Indirect IF with the vegetating bases and surrounding areas (Fig. 2).