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Topical application of capsaicin to human skin produced an initial burning erythematous reaction which diminished over 24 hr leaving the skin unresponsive to histamine-induced axon reflex vasodilatation without altering sensitivity to pain, touch and temperature. Depletion of substance P from local sensory nerve terminals is suggested as a possible explanation for this capsaicin effect.

Patients with moderate to severe bullous pemphigoid are usually treated with systemic corticosteroids. Four patients were treated with tetracycline hydrochloride and niacinamide because of the steroid-sparing anti-inflammatory properties of these agents. An excellent clinical response free of side effects was observed in all patients. The lesions recurred whenever treatment was discontinued. It is believed that these drugs suppress the complement-mediated inflammatory response at the basement membrane zone by suppressing neutrophil chemotaxis and mediators of the inflammatory response in this bullous disease.

We here report the unusual occurrence of bullous pemphigoid mimicking prurigo nodularis in a 59-year-old woman. Direct immunofluorescence studies of a nodular lesion revealed linear deposition of IgG and C3 at the epidermal basement membrane zone (EBMZ). Indirect immunofluorescence studies of serum revealed IgG pemphigoid antibasement membrane zone antibodies in 1:1,280 titer. This entity can be distinguished from other bullous pemphigoid variants.