Bullous pemphigoid

Deba P Sarma, MD Omaha

M 74, left thigh

Subepidermal paucicellular bulla, upper dermal inflammation

Eosinophils are abundant in the bulla

Prominent eosinophilic infiltration in the upper dermis

Results of DIF: Linear deposits of IgG and C3 at BMZ

IgG deposits at basement Membrane zone

Bullous pemphigoid

Clinical: Seen in childhood and in the elderly. Tense bullae that break spontaneously. Trunk, limbs, and mucosal surfaces are affected.
Microscopic: Subepidermal bulla with scant inflammatory infiltrate, eosinophils may predominate. Differential Diagnosis: Pemphigus vulgaris, herpes gestationis, cicatricial pemphigoid, dermatitis herpetiformis, linear IgA dermatosis, erythema multiforme. Direct immunoflourescence: Linear IgG and or C3 deposits at the basement membrane zone (BMZ).

Summary

- Subepidermal eosinophilic bullous dermatitis. - Eosinophilic infiltrates in the bulla and in the dermis. - Perivascular lymphocytic and eosinophilic infiltrates in the upper dermis. - Older bulla shows intraepidermal blister due to reepitheliazation. - DIF: Linear deposits of IgG and or C3 along the dermoepidermal junction