Case history
Case history
A 68-year-old man presents with a 3-month history of an itchy red rash on his torso and extremities. Over the past week, he has developed increasing numbers of tense, fluid-filled blisters on the inner arms and legs. Some of the blisters become bloody within a few days, then dry up and scab over, while others burst to produce raw, moist erosions. The itch is severe and wakes him up at night. He has no other complaints.
Other presentations
Occasionally, blisters are limited to one body area and remain localised, such as on the shins (pretibial pemphigoid) or in the form of blisters on the palms and soles (dyshidrosiform pemphigoid). The disorder may present with small, tense, clustered vesicles only several millimetres in diameter (vesicular pemphigoid). Rarely, individual lesions are nodular, mimicking prurigo nodularis (nodular pemphigoid). If the initial, prodromal eruption involves the entire skin, the patient presents with erythroderma (erythrodermic pemphigoid) and subsequently develops isolated bullae. All these atypical presentations and variants are commonly accompanied by pronounced pruritus and tense blisters that last for days before rupturing. Oral lesions are present in up to one third of all patients, but seldom produce a functional deficit.[4] The generalised form is rare and may present much like psoriasis or atopic dermatitis, which may develop into vesicles or bullae. The urticarial form initially presents as itchy areas that then become bullae. However, sometimes bullae do not form. There is also a childhood form that is associated with vaccinations, in which bullae appear on the face, palms, and soles of the feet.
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