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We present a unique case of an 89-year-old male with Alzheimer's disease who developed hemorrhagic blisters on his palms, which ruptured with time and were followed by pruritic erythematous lesions across his chest, upper back, lower abdomen, and thighs. The patient was diagnosed with dyshidrosiform bullous pemphigoid (DBP), an uncommon variant of the autoimmune condition bullous pemphigoid characterized by cutaneous and mucosal blistering, which commonly appears as vesiculobullous eruptions in the palmoplantar areas and may spread to other parts of the body. Less than 100 cases of DBP have been documented in the medical literature.

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Bullous pemphigoid (BP) is an autoimmune disorder which is usually chronic, with blistering that predominantly affects the skin and occasionally the mucosa, and which includes several different types. One of them is a very rare dyshidrosiform type which is localized on the hands and feet with small or large blisters on the palmoplantar surfaces. BP resulting from a drug reaction is a relatively rare occurrence, and so far more than 50 different medications have been identified as triggers.

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Purpuric bullous pemphigoid.

Am J Dermatopathol

February 2015

*Department of Dermatovenerology, University Medical Centre Maribor, Maribor, Slovenia; and †Department of Dermatology, University Hospital Graz, Graz, Austria.

Rare clinical variants of bullous pemphigoid (BP) include vesicular BP, dyshidrosiform BP, pemphigoid nodularis, seborrheic BP, pemphigoid vegetans, localized BP, erythrodermic BP, and juvenile BP. To our knowledge, this is the first report of an unusual case of purpuric BP. We present a case of 85-year-old white man who presented with a 2-week history of blisters and pruritic urticarial lesions all over his body.

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We report two cases of dyshidrosiform pemphigoid (DP) with different presentations. One patient was a 65-year-old Japanese man, who had been diagnosed with dyshidrosis and had been treated before visiting our hospital. When we stopped all treatments, the vesicles increased and spread to the trunk and limbs.

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