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Bullous pemphigoid — RACP Adult Medicine MCQ

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ModerateDermatologyBullous pemphigoidRACP Adult Medicine

An 83-year-old woman has widespread itchy tense blisters on erythematous skin. Oral mucosa is spared. Skin biopsy shows a subepidermal blister with eosinophils, and direct immunofluorescence shows linear IgG and C3 along the basement membrane. What is the most likely diagnosis?

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Correct answer: E — Bullous pemphigoid

Tense pruritic bullae in an older adult with subepidermal blistering and linear basement membrane IgG/C3 indicate bullous pemphigoid. Pemphigus vulgaris causes flaccid blisters and mucosal disease with intercellular IgG. Dermatitis herpetiformis, SJS and bullous impetigo have different distribution, histology or clinical severity.

Reference: Australasian College of Dermatologists resources; AMH