By Gary M. White, MD
Dyshidrosiform pemphigoid (DP) is a rare, localized variant of bullous pemphigoid affecting the palms and soles. The reason for the localization is unclear.
Persistent vesicles and bulla, which commonly become hemorrhagic of the palms and/or soles is characteristic. Older patients, just as with bullous pemphigoid, are typically affected but younger patients may be affected as well [Acta Dermato-Venereologica 2010;90;80-81]. DP may occur in isolation or may precede generalized bullous pemphigoid.
Diagnosis is confirmed by biopsy and a positive direct immunoflourescence which shows the typical characteristics of bullous pemphigoid. In the differential diagnosis is dyshidrosiform pemphigus which is even rarer [Dermatology Online Journal]. Salt-split skin analysis showing IgG and C3 staining the epidermal roof excludes epidermolysis bullosa acquisita.
A potent topical steroid should be started initially. If this fails, minocyline 100 mg po BID can be effective as monotherapy [JAMA Dermatol 2015;151;99-100]. Other oral agents may be tried including systemic corticosteroids, dapsone, mycophenolate mofetil, or azathioprine.
Bulla were present on both palms for one year. Acta Derm Venereol 2010;90;80
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