Vesicular Bullous Pemphigoid in a 23-Year-Old Male.

Abstract

Vesicular bullous pemphigoid (BP) is a rare variant of BP. Unlike typical BP with large, tense, serous or hemorrhagic bullae, vesicular variant presents multiple small tense vesicles with a symmetrical distribution, which is clinically similar to dermatitis herpetiformis. Here we report a case of vesicular BP in a young male patient. A 23-year-old male presented to our department with a 2-month history of multiple, grouped, symmetric vesicles and excoriations with severe pruritus on the whole body. Skin biopsy showed subepidermal bullae with neutrophil and occasional eosinophil infiltrations. Direct immunofluorescence (DIF) showed linear IgG, IgA and complement 3 depositions along the basement membrane zone. Indirect IF using salt split skin showed linear IgG deposition on the epidermal side. Based on these histologic findings and IF examination, he was diagnosed as vesicular BP. The response to medication was good and symptoms were effectively controlled with 12mg daily of oral methylprednisolone and 50mg dapsone, which were tapered without relapse. BP may occur in a variegated and deceiving manner, and bullae are sometimes missing the initial phases or even throughout the entire course. A Careful evaluation with histologic and IF examination is needed for the diagnosis and treatment of these atypical clinical variants.