Abstract
A 62-year-old man with a 5-year history of dyshidrosiform dermatitis on the palms and soles presented with whole body exacerbation of the eruptions accompanied with severe itch. Physical examination revealed widespread erythematous macules and papules with erosions and tiny ulcers due to scratches on the body surface, as well as lichenoid and pruriginous eruptions on the proximal extremities. No large blister was found. On the palms and soles, dyshidrosiform and hemorrhagic vesicle, small blisters and erosive eruptions are distributed. Histological examination revealed ghost basal cells (eosinophilic masses in which the nuclei disappeared) arranged beneath the previous blister roof, newly formed bullae, that looked intraepidermal but channeled to the dermis, in the renewed epidermis, and severe eosinophilic infiltration in the upper dermis.Direct immunofluorescence revealed linear deposits of IgG and C3 along the basement membrane zone of the epidermis. ELISA examination disclosed anti-BP 180 antibodies (index 320) in the patient’s serum. Based on the diagnosis of dyshidrosiform pemphigoid with widespread exacerbation, combination therapy of prednisolone (30mg/day at first dosage), minocyclin (150mg/day) and nicotinamide (900mg/day) was started and the eruptions vanished in the following several days. We concluded this case as a type of pemphigoid widespread from dyshidrosiform pemphigoid due to exacerbating factors.
