What Is This Blistering Disorder?

Can you identify the skin condition in the left photo?

This condition accounts for the majority of autoimmune blistering diseases. The disorder most frequently affects the elderly with nearly two-thirds of cases occurring in individuals over 70.

The hallmark of the condition is the appearance of tense blisters. Untreated, it can persist for months and even years. The diagnosis is often clinical (the presence of bullae in an elderly patient) and confirmed by light microscopy and immunofluorescence. Regarding the latter, the optimal biopsy site is from normal appearing peri-lesion skin.

The treatment of choice for moderate to severe disease is oral steroids that one gradually tapers upon remission to avoid rebound flare. Milder cases often respond to topical therapy with ultrapotent steroid creams.

What is your diagnosis?

a. Bullous pemphigoid

b. Infantile acropustulosis

c. Epidermolysis bullosa simplex

d. Epidermolysis bullosa dystrophica

Editor’s note: This blog is adapted from the handbook, Skin Disease Of The Lower Extremities: A Photographic Guide, from Tracey Vlahovic, DPM, and Stephen M. Schleicher, MD. The book is available for purchase at www.lowerextremityderm.com . The e-book version is available for purchase at https://tinyurl.com/7itt66v , https://tinyurl.com/7j44vez and https://tinyurl.com/couepf5 .