Bullous pemphigoid appearing both on thermal burn scars and split‐thickness skin graft donor sites

Abstract

Dear Editors,Bullous pemphigoid (BP) is a common subepidermal autoimmune bullous disease. A number of external agents have been associated with its development, including trauma, thermal burns, skin grafts, radiotherapy, ultraviolet exposure (UVB, PUVA), photodynamic therapy, surgery, vaccination and cutaneous infections. An 85-year-old woman presented with a two-month history of blistering lesions on the back, legs and abdomen ( Figure 1). She complained generalized itch and had widespread erosions and crusts on erythematous skin. Remarkably, all the lesions appeared on thermal burn scars (some of which had been covered with meshed split-thickness autografts 20 months before) and on donor sites. Her medical history included hypertension and atrial fibrillation and she had been treated with a calcium channel blocker and warfarin for several years. Skin biopsies from both scar area and donor site revealed a subepidermal detachment and superficial dermal infiltrate consisting of lymphocytes and eosinophils. Direct immunofluorescence showed linear deposits of IgG and C3 at the basement membrane and BP180 ELISA was positive, confirming the diagnosis of localized BP.

Bullous Pemphigoid Triggered by Thermal Burn Under Medication With a Dipeptidyl Peptidase-IV Inhibitor: A Case Report and Review of the Literature

“…Herein, we report a case of BP in which a thermal burn triggered the onset of the disease. As shown in Table 1 , various BP-inducing physical factors, including radiation ( 5 , 10 – 18 ), UV radiation ( 5 , 19 – 30 ), surgical wounds ( 5 , 31 – 45 ), ostomy ( 31 , 46 – 51 ), burns ( 5 , 52 – 62 ), skin grafts ( 59 , 63 – 67 ), and other trauma ( 5 , 68 – 72 ) have been reported in the English literature. Regarding thermal burns, 13 cases have been reported (Table 2 ) ( 5 , 52 – 61 ).…”

Radiation dermatitis, burns, and recall phenomena: Meaningful instances of immunocompromised district

“…On the contrary, the onset of autoimmune bullous diseases, such as pemphigus, 45 bullous pemphigoid, 46 or linear IgA dermatosis, 47 on thermal burn scars indicates an upregulation of immunity in burned skin areas. The occurrence of any skin disorder on a burn scar can be defined as an isocaumatopic response, from the Greek καũμα (meaning burn scar).…”

Necrotizing Fasciitis—Severe Complication of Bullous Pemphigoid: A Systematic Review, Risk Factors, and Treatment Challenges

“…Such reconstructions were performed in patients not eligible for skin grafting, while skin grafting reports are found as individual successful cases in the literature [68,74]. Still, various reports of skin grafting-induced eruptions of bullous pemphigoid on both skin graft and donor sites could be limiting factors for reconstruction of defects in these patients [75][76][77][78][79]. Additionally, in patients with >10 bullae per day or with the Bullous Pemphigoid Disease Area Index (BPDAI) severity score of ≥20 points equaling to a moderate or severe form of BP, in whom remission is not achieved, surgical reconstruction could be limited due to the insufficient healthy skin and soft tissue for flaps or donor sites.…”