An 81-yo man presented with 10-day hx of profoundly itchy, blistering rash. Exam revealed >100 blisters with sparing of mucous membranes. Nikolsky sign negative. Labs normal except for elevated CRP. What is it?
Nummular eczema
Tinea corporis
Bullous pemphigoid
Insect bites
Cellulitis
You are correct. Bullous pemphigoid is the most common autoimmune subepidermal blistering disorder. It is typically associated with age >70 years, nonatrophic scars, relative sparing of head and neck, and no mucosal involvement. Pruritus is typical. Diagnosis is confirmed by histology and immunofluorescence. Mild to moderate disease is treated with potent topical steroids. Oral steroids +/- tetracycline with nicotinamide are used for severe disease. The patient was blister free 2 weeks after starting prednisolone.