Localized Blistering Eruption of the Face and Neck – A Case Study and Differential Considerations

Abstract

We describe a 36-year-old woman with erythematous lesions and well-tense blisters confined to the face and neck of two months history, without mucosal involvement and no triggering factors. A lesional skin biopsy showed a subepidermal blister. Direct immunofluorescence of peribullous skin identified linear deposits of IgG, IgA, and C3 complement along the basement membrane zone, whereas indirect immunofluorescence was negative. Using fluorescence overlay antigen mapping by laser scanning confocal microscopy, linear immunoglobulins deposits were found to be located above collagen IV and below laminin 332 (formerly named laminin 5), in a pattern typical of mucous membrane pemphigoid (formerly named cicatricial pemphigoid). Consequently, in terms of the clinical picture and confocal study, a rare variant of mucous membrane pemphigoid was established, namely Brunsting-Perry type. Combined therapy with oral prednisone and dapsone healed the lesions, leaving atrophic scars and milia. The paper also provides a review of previous reports on this item as well as a comprehensive differential diagnosis of facial blistering lesions.

Brunsting‐Perry type pemphigoid with IgG antibody against full‐length BP180 mimicking squamous cell carcinoma

“…Several potential triggering factors in BPP have been reported, including mechanical trauma, drugs (e.g., dipeptidyl peptidase-4 inhibitor, sartans), and sun exposure. [1][2][3] In our case, scratching the itchy scalp may have formed a skin ulcer, which was enlarged by subsequent scratching.…”

“…Dear Editor, Brunsting-Perry type pemphigoid (BPP) is a rare variant of autoimmune bullous dermatosis that presents with vesiculobullous lesions on an erythematous base, evolving in scars, and is limited to the scalp, face, and neck. [1][2][3] Here, we present a case of BPP resembling squamous cell carcinoma (SCC).…”

“…[1][2][3] In particular, BP180 was the most common BPP autoantibody and only a few cases of BPP showed positive reactivity other than against the BP180 NC16a domain. [1][2][3] In our case, IgG antibody reactivity against the BP180 NC16a domain was negative, whereas IgG antibody reactivity to full-length BP180 recombinant proteins was positive, indicating the immunological diversity of antibodies against basement membrane zone proteins.…”