Recurrent bullous pemphigoid: A case report and literature review

Abstract

The present study aimed to enhance the current understanding of the etiopathogenesis, predisposing factors, clinical features and current management modalities for bullous pemphigoid (BP). BP is a chronic autoimmune disorder mediated by antibodies targeting BP180, a type XVII collagen (BPAG2), and BP230, a hemidesmosome protein located in basal keratinocytes, resulting in the formation of subepithelial blisters and multiple chronic oral ulcers, which heal without scarring, as well as urticarial lesions on the extremities. The BP lesions occur in the oral cavity following the onset of pruritic papules in the extremities. The present study describes the case of a patient with recurrent BP who was hypertensive and treated with amlodipine. In addition, a detailed search was performed on the PubMed database by searching the key word 'bullous pemphigoid'; ~33 articles were selected which were published from 2005-2022 for inclusion and discussion in the literature review. Studies published prior to 2005 were excluded. The anti-hypertensive drug, amlodipine, has a high propensity for BP lesions. However, caution needs to be taken when prescribing amlodipine for hypertension. The occurrence of BP must not be overlooked, and the oral physician must seek a complete detailed drug history and clinical examination, which will aid in the diagnosis of BP. BP lesions are usually multiple and have a chronicity and usually affects the oral mucosa, upper torso and arms. There is a period of exacerbations and remissions. On the whole, the present study provides insight into the etiology, predisposing risk factors, etiopathogenesis, clinical features and management modalities for BP.

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“…The results of the multivariate analysis conducted in these studies indicate a substantial association between the long-term use of spironolactone and BP, with odds ratios ranging from 2.3 to 3.1. However, a retrospective study did not find a significant association when adjusting for factors like age and co-morbidities [15]. Diagnosis of BP employs clinical, histological, and immunopathological methods using direct or indirect immunofluorescence.…”

“…Excoriation, eczema, urticaria, and hemorrhagic crusts may appear during this phase. In the bullous stage, severe itching and multiple tight blisters and vesicles occur on normal or reddened skin [15]. The intensity of itch can precede blister formation over weeks, months, or even years [16].…”