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Bullous pemphigoid (BP) is an exceptional autoimmune skin disease with the tendency on the elderly. Localized BP is one of the clinical alternatives of pemphigoid, which includes three basic entities based on the affected site and disease consequence: mucous membrane pemphigoid, Brunsting-Perry pemphigoid, and localized non-scarring pemphigoid. A rare location of localized BP is described here.
A 42-year-old woman presented with a 7-month history of itchy erythema on her trunk. The lesion, well-demarcated erythema and maculopapules had been misdiagnosed as contact dermatitis.
Histopathological examination revealed a subepidermal blister with eosinophils and neutrophils infiltration. Salt-split indirect immunofluorescence revealed linear deposition of IgG at the dermoepidermal junction. All lesions resolved within 1 month after treating with minocycline and nicotinamide per day, Localized BP is usually misdiagnosed. It starts from various triggers and has a more benign disease course. It should be emphasized that a long-term follow-up of patients with localized BP may be important for management of the chronic disease, given a relatively high risk of developing generalized BP.
The occurrence of localized BP is unusual and caused attention from 1965 (2), since when few cases have been reported, mainly at the location of the extremities (3-7). The present case describes a patient with localized non-scarring pemphigoid on the breast. The distribution of skin lesions is so rare in BP that misdiagnosis for other dermatological diseases had been diagnosed.
Treatment of the patient with minocycline 200 mg and nicotinamide 1,500 mg per day resulted in complete remission of the skin lesions within 1 month. No relapse was noticed at the follow-up of 12 months and serum anti-BP180 antibody titre was controlled in normal range.
It should be accentuated that a long-term follow-up of patients with localized BP may be important for management of the chronic disease, given a relatively high risk of developing generalized BP. This case reports a new location of localized BP that is supposed to be triggered by pressure, while the mechanism behind pressure and localized BP remains to be further discovered.