A 70-year-old man develops multiple pruritic skin lesions and bullae mostly in the axillae and around the medial aspects of his groin and thighs. There are some lesions on his forearms and on his lower legs (first appeared in this location), and moderately painful oral lesions. Nikolsky sign is negative. There is no eye involvement. Which of the following is the most likely diagnosis?
The description and age range (60-80) is typical of bullous pemphigoid. PV is usually associated with a positive Nikolsky sign (pressure on blister leads to lateral extension), and very severe oral lesions. Cicatricial pemphigoid is also a disease of the elderly, but is rare and usually involves the eyes as well. EB is an inherited disorder that usually presents in earlier life. DH does not usually affect mucous membranes, and the lesions are grouped in clusters. However, it can mimic early bullous pemphigoid, and biopsy is needed for confirmation. Permanent remission is frequent, and continued therapy would not be required.
dermatitis herpetiformis (DH)
pemphigus vulgaris (PV)
bullous pemphigoid
cicatricial pemphigoid
Skin