Clinical Features

In the prodromal, non-bullous phase manifestations of BP are frequently nonspecific and, thus, misleading. Patients complain of severe itch accompanied or not by excoriated, eczematiform, papular and or urticarial lesions that may persist for several weeks or months, or even remain the only signs of the disease.

Imagen Diagn Stico Vih

Fig. 1. Bullous pemphigoid. Panel A: bullous lesions on the forearms; Panel B: urticarial erythema and elevated inflammatory plaques on the trunk distributed in a figurate pattern; Panel C: prurigo nodularis-like presentation with generalized papular and excoriated lesions; Panel D: childhood form of bullous pemphigoid with vesicular and bullous lesions arranged in jewel-like clusters. The patient had IgA autoantibodies targeting BP180

Fig. 1. Bullous pemphigoid. Panel A: bullous lesions on the forearms; Panel B: urticarial erythema and elevated inflammatory plaques on the trunk distributed in a figurate pattern; Panel C: prurigo nodularis-like presentation with generalized papular and excoriated lesions; Panel D: childhood form of bullous pemphigoid with vesicular and bullous lesions arranged in jewel-like clusters. The patient had IgA autoantibodies targeting BP180

In the bullous stage vesicles and bullae develop on apparently normal or erythematous skin together with urticated and infiltrated plaques that have occasionally an annular or figurate pattern. The blisters are tense, with a clear exudate, and may persist for several days, leaving eroded and crusted areas (Figure 1). The lesions are frequently distributed symmetrically and predominate on the flexural aspects of the limbs, and abdomen. In the intertriginous spaces, vegetating plaques can be observed. Involvement of the oral cavity is observed in 10-30% of cases. The mucosae of eyes, nose, pharynx, esophagus and ano-genital areas are more rarely affected (reviewed in Lever 1953; Liu et al. 1986; Korman 1987).

Several clinical variants of BP have been described (reviewed in Liu et al. 1986; Korman 1987). Lesions remain occasionally localized, such as on the pretibial area ("pretibial pemphigoid"), around stomas, on the vulvar region ("vulvar pemphigoid"), on irradiated areas or confined to a paralyzed limb. Palmo-plantar involvement mimicking dyshidrosiform eczema ("dyshidrosi-form pemphigoid") might be observed. Several other variants, such as a prurigo nodularis - ("pemphigoid nodularis"), and an erythroderma-like form have been described. These variants have all been described with various

Neonatal Pemphigus

Fig. 2. Panel A: pemphigoid gestationis: urticarial erythema, vesicles and bullae in the periumbelical area and abdomen; Panel B: transplacentar passage of autoantibodies from a mother with gestational pemphigoid: neonate with a generalized eruption consisting of erythematous plaques with a figurate configuration and blisters; Panel C: bullous pemphigoid: light microscopy study shows a subepidermal blister with an inflammatory infiltrate in the blister cavity and in the upper dermis consisting predominantly of eosinophils and neutrophils; Panel D: bullous pemphigoid: direct immunofluorescence microscopy depicting linear IgG deposits in the epidermal basement membrane

Fig. 2. Panel A: pemphigoid gestationis: urticarial erythema, vesicles and bullae in the periumbelical area and abdomen; Panel B: transplacentar passage of autoantibodies from a mother with gestational pemphigoid: neonate with a generalized eruption consisting of erythematous plaques with a figurate configuration and blisters; Panel C: bullous pemphigoid: light microscopy study shows a subepidermal blister with an inflammatory infiltrate in the blister cavity and in the upper dermis consisting predominantly of eosinophils and neutrophils; Panel D: bullous pemphigoid: direct immunofluorescence microscopy depicting linear IgG deposits in the epidermal basement membrane terms: only dermatologists can afford to have so different names for the same condition!

A peculiar form of BP typically associated with pregnancy, for which a separate term appears justified, is gestational pemphigoid (also called "pemphigoid gestationis" or "herpes gestationis") (reviewed in Shornick 1993; Jenkins et al. 1993). This disease is also rarely found with either a choriocarcinoma or an hydatiforme mole. Gestational pemphigoid, the estimated frequency of which is of one case for 10'000 to 40'000 pregnancies, starts during the second or third trimester of pregnancy or, more rarely, after delivery. In the early phase, itchy papular and urticated lesions are observed, with later on development of vesicles and bullae (Figure 2). The eruption begins on the perium-belical and abdominal area and can generalize. Relapses are frequently observed during subsequent pregnancies and they might be triggered by either menstruation or intake of oral contraceptives.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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