Localized Blistering Eruption of the Face and Neck - A Case Study and Differential Considerations

• Published in: Clinical, cosmetic and investigational dermatology Vol. 15; pp. 271 - 281
• Main Authors: Michalska-Jakubus, Małgorzata, Wdowiak-Filip, Anita, Kowalewski, Cezary, Woźniak, Katarzyna, Krasowska, Dorota
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 28.02.2022; Dove; Dove Medical Press
• Subjects: Analysis; Antigens; brunsting-perry pemphigoid; Case Report; Case studies; Collagen; Immunoglobulin A; Immunoglobulin G; Laminin; laser scanning confocal microscopy; mucous membrane pemphigoid; Skin; Poland; laser scanning confocal microscopy; mucous membrane pemphigoid; Brunsting-Perry pemphigoid
• ISSN: 1178-7015; 1178-7015
• DOI: 10.2147/CCID.S350743

We describe a 36-year-old woman with erythematous lesions and well-tense blisters confined to the face and neck of two months history, without mucosal involvement and no triggering factors. A lesional skin biopsy showed a subepidermal blister. Direct immunofluorescence of peribullous skin identified linear deposits of IgG, IgA, and C3 complement along the basement membrane zone, whereas indirect immunofluorescence was negative. Using fluorescence overlay antigen mapping by laser scanning confocal microscopy, linear immunoglobulins deposits were found to be located above collagen IV and below laminin 332 (formerly named laminin 5), in a pattern typical of mucous membrane pemphigoid (formerly named cicatricial pemphigoid). Consequently, in terms of the clinical picture and confocal study, a rare variant of mucous membrane pemphigoid was established, namely Brunsting-Perry type. Combined therapy with oral prednisone and dapsone healed the lesions, leaving atrophic scars and milia. The paper also provides a review of previous reports on this item as well as a comprehensive differential diagnosis of facial blistering lesions.