Pruritus Alone or in Conjunction with Nonbullous Skin Lesions Might Still Represent Bullous Pemphigoid

Bullous pemphigoid (BP) is a disease of older people and characteristically presents as tense blisters on an erythematous or urticarial base. Some patients present with urticarial lesions only, which has been considered a prebullous phase of disease. In the entity known as pemphigoid nodularis, prurigo nodularis-like lesions are the only manifestation of BP. Patients with pruritus without a known cause might have bullous pemphigoid, but the frequency of this occurrence is not clear.

In this retrospective analysis, 15 patients (all but 1 elderly) seen over a 10-year period were diagnosed with bullous pemphigoid based upon immunofluorescence findings. The average delay to diagnosis was 2.8 years, and for an average of 2.2 years, no blisters we…