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Bullous Pemphigoid — SCE Dermatology MCQ

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EasyBlistering DiseasesBullous PemphigoidSCE Dermatology

A 78-year-old man develops tense blisters on erythematous and urticarial skin of his limbs and trunk. Biopsy shows a subepidermal blister with eosinophilic infiltrate. Direct immunofluorescence shows linear IgG and C3 along the basement membrane zone. What is the most likely diagnosis?

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Correct answer: B — Bullous pemphigoid

Bullous pemphigoid is the most common autoimmune blistering disease in Western populations, predominantly affecting the elderly. Key features: tense blisters (subepidermal), urticarial plaques, eosinophilic infiltrate on histology, and linear IgG/C3 at the basement membrane zone on DIF. Pemphigus vulgaris shows intraepidermal blistering with intercellular IgG ('fishnet' pattern). Linear IgA disease shows linear IgA (not IgG). Dermatitis herpetiformis shows granular IgA at dermal papillae.

Reference: BAD 2012 Guidelines for management of bullous pemphigoid