Two cases of dyshidrosiform pemphigoid with different presentations

Abstract

We report two cases of dyshidrosiform pemphigoid (DP) with different presentations. One patient was a 65-year-old Japanese man, who had been diagnosed with dyshidrosis and had been treated before visiting our hospital. When we stopped all treatments, the vesicles increased and spread to the trunk and limbs. We made a diagnosis of vesicular pemphigoid (VP) that was concomitant with or transformed from DP. Using Western blotting, the sera reacted with antigens with molecular weights of 60 and 180 kDa. The 60-kDa antigen has not been found previously in the sera of patients with VP. The other patient was a 94-year-old Japanese woman, who presented with redness and swelling with bullae on the palmoplantar areas. Five days later, areas of oedematous erythema, as seen in prototypical bullous pemphigoid (BP), developed on the limbs. Study of the distribution of the BP antigen may elucidate the mechanisms involved in localized forms of BP such as DP.

Dyshidrosiform pemphigoid restricted to the soles

“…In the first type, vesiculobullous lesions initially develop on the palmoplantar areas and later spread to other parts of the body. In the second type, vesiculobullous lesions localize on the palms and/or soles throughout the course of disease . Although most reported cases are of the former type, our case was of the latter type, and the patient showed bullae localized to the soles.…”

“…Dyshidrosiform pemphigoid (DP) is a rare dermatosis characterized by persistent, localized vesicles, or bullae that are largely limited to the soles and/or palms . DP is regarded as a variant of localized bullous pemphigoid (BP) .…”

Atypical presentations of bullous pemphigoid: Clinical and immunopathological aspects

“…Borradori et al reported a case of pretibial pemphigoid evolving after 5 years in a generalized pemphigoid nodularis eruption [72]. Yasuda et al instead, described a case of dyshidrosiform pemphigoid concomitant to vesicular pemphigoid [135].…”

A tale of an acral bullous eruption

“…2 In most cases, the eruption initially developed on palmoplantar surfaces and later spread to other parts of the skin or occurred concomitantly with generalized tense bullae of classic BP. 3 Cases in which a palmoplantar eruption was the only presenting manifestation, without further spread to other skin areas, are much rarer. 4 In our patient, the hands and feet were the only involved sites, and long-term follow-up did not reveal subsequent involvement of other sites.…”