Bullous Pemphigoid Can Present as Pruritus Without Bullae

We usually think of bullous pemphigoid as a blistering skin disease, but it can present without bullae. In this report from a specialty skin clinic in the Netherlands, dermatologists describe 15 patients with bullous pemphigoid who presented with itching but no blisters. These patients (mean age, 82; mean delay between symptom onset and diagnosis, 3 years) represented 12% of the clinic's bullous pemphigoid cases.

Twelve patients had pruritus with various types of excoriated skin lesions (eczematous, urticarial, papular, or nodular); the other 3 patients had pruritus and excoriations but no visible skin lesions. All patients tested positive for bullous pemphigoid by either positive direct immunofluorescence on skin biopsy or indirect immunofl…