Bullous Pemphigoid in a Young Female: A Case Report

Abstract

Introduction: Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease, mediated by autoantibodies against hemidesmosomal proteins BP180 and BP230, which activate complement, recruit eosinophils and neutrophils, and produce subepidermal bullae. Although BP typically affects older adults, it can occasionally arise in young patients, and prompt recognition and objective disease activity monitoring are important.

Case Description: A 22-year-old woman presented with a two-week history of pruritic, fluid-filled tense bullae over the trunk, axillae, forearms, palms, and thighs, which were unresponsive to topical betamethasone and cetirizine. Examination revealed tense, clear, and haemorrhagic bullae on erythematous macules with a negative Nikolsky’s sign, and the initial Bullous Pemphigoid Disease Area Index (BPDAI) was 23 (moderate). Histopathological examination revealed subepidermal bullae with eosinophil- and neutrophil-rich infiltrates, confirming BP diagnosis. Laboratory testing revealed thrombocytopenia underlying the haemorrhagic lesions, and oral mucosal involvement was observed during follow-up. She was treated with systemic and topical corticosteroids, an antihistamine, and supportive care. The BPDAI progressively decreased to 17 at two weeks and 7 at three weeks, with no new lesions.

Conclusion: Oral and topical corticosteroids were effective in treating moderate bullous pemphigoid in this patient. Serial BPDAI scoring provides a practical, objective measure of treatment response and supports timely dose adjustment.

Keywords: Autoimmune Blistering Disease, BPDAI, Bullous Pemphigoid, Corticosteroid, Young Female