Most inflammatory dermatoses are less common in older persons than in young or middle-aged adults, but some inflammatory dermatoses—particularly vesiculobullous eruptions caused by circulating autoantibodies—are more common in patients older than 60 years.
Bullous pemphigoid, a chronic, autoimmune, subepidermal disease, mostly affects older persons in the fifth through seventh decades of life. The average age at onset is 65 years.
The various forms of bullous pemphigoid include generalized bullous, vesicular, vegetative, generalized erythroderma, urticarial, nodular, and acral. The last form is seen on this man’s hand.
Bullous pemphigoid, which manifests with tense blisters, usually starts on the arms and legs and rarely involves the mucous membranes. The differential diagnosis includes other blistering diseases, urticaria, and vesicular types of eczema. The diagnosis is established with a biopsy sample prepared for and examined with direct immunofluorescence.
Case and photo provided by Noah S. Scheinfeld, MD, JD