Abstract

Bullous pemphigoid (BP) is a comparativelycommon autoimmune vesicobullous. It is a subepidermal bullous ailment most commonly seen in the elderly and reveals as tense blisters on urticarial base, predominantly over flexures, and is associated with pruritus. The analysis can be confirmed by histology, direct and indirect immunofluorescence. Several new diagnostic techniques have also been developed. Treatment of BP is based on the extent and rate of progression of the disease. Several topical and systemic anti-inflammatory and immunosuppressive agents have been used with variable results.

The relationship of bullous pemphigoid with melanoma remains debatable and poorly understood. Several studies report the presence of the BP antigen, BP180, in melanoma cells, yet not normal melanocytes, advising an underlying mechanism for cases of melanoma-associated BP. We report a case of a 65-year-old woman who was presented with a temporal association between the development of BP and melanoma.

Case Report

A 65-year-old woman initially presented for assessment of a pruritic rash. On skin exam, she had multiple pink papules on both thighs and erythema and excoriations on her back. There were no blisters noted at early presentation. In the course of the full skin exam, a pigmented lesion was noted on her clitoral hood. The patient stated that this had been present for an unknown period of time, but that she had noted growth over the course of 4 months.

On physical exam, she still had multiple pink papules on the legs, as well as erythema and excoriations on her back with few small tense bullae. A biopsy was executed from a characteristic lesion. Pathology indicated vacuolar interface changes, mild spongiosis, and clusters of junctional eosinophils. The findings were constant with a diagnosis of BP.

Management of BP in this patient was started with niacinamide thrice daily and doxycycline 100 mg twice daily were added. After 15 days, her lesions had resolved almost completely and she did not develop new bullae. This treatment schedule was continued for 5 months, all through that time she did not develop any new lesions nor experience significant pruritus.

Subsequently, the patient was able to be managed on niacinamide without flares.