Pemphigus and bullous pemphigoid. 70 y/o woman with cutaneous lesions

This woman has this cutaneous lesions distributed all over the body. She has history of vitiligo.

Pemphigus and bullous pemphigoid.

These are autoimmune blistering diseases. They are caracterized by the production of antibodies directed against different epitopes, resulting in intraepidermal blistering in pemphigus and subepidermal blistering in pemphigoid. The term pemphigus comes from the greek, pemphix, that means bubble. It was used to describe most blistering diseases until 20th century.

Pemphigus
Pemphigus is a group of rare, chronic, autoimmune and potentially fatal diseases of mucous membranes and skin.Three types of pemphigus have been described:

Pemphigus vulgaris
Pemphigus foliaceus
Paraneoplastic pemphigus

Is caracterized by the production of autoantibodies, in pemphigus vulgaris IgG, against adhesion proteins. This alters the intercellular cement that holds epidermal cells together. Resulting in blister formation. Clinically is caracterized by flaccid bullae that tipically begin in the oropharynx and then may spread to involve the skin. With a predilection for the scalp, face, chest, axillae and groin.

Bullous Pemphigoid
Mostly afects persons 60 yeard of age and older. Pemphigoid refers to pemphigus-like blistering disease but is less aggressive than pemphigus vulgaris. It is also a chronic and recurrent disease of autoimmune origin. As in pemphigus vulgaris, the precise reason for the formation of autoantibodies is unkown. A small group of patient bullous pemphigoid is drug-induced. Penicillamine and furosemide are the most frequently implicated. A common presentation is a widespread blistering eruption in a middle age or eldery person who is taking multiple medication.

The case above was diagnosed as bullous pemphigoid.

Regards,

Gerardo Morales-Mora, M.D.