Bullous pemphigoid evolving into cicatricial pemphigoid?
We describe three patients who initially presented with both clinical and immunological findings to support a diagnosis of bullous pemphigoid but whose subsequent course has been that of cicatricial pemphigoid. Mucosal scarring was accompanied by a fall in autoantibody titres in our three patients. These cases illustrate the difficulties clinicians may experience in assigning a specific diagnosis to patients. They also support the concept that bullous pemphigoid and cicatricial pemphigoid are part of a single disease spectrum. The most intriguing question is what specific factors determine the expression of a particular disease phenotype as bullous pemphigoid and cicatricial pemphigoid share target antigens and also the DQ7 allele.
Banfield
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CC
Department of Dermatology, Churchill Hospital, Headington, Oxford, UK.
Papadavid
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E
Frith
P
P
Allen
J
J
Wojnarowska
F T
FT
D000368:Aged; D003176:Complement C3 / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010390:Pemphigoid, Benign Mucous Membrane / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D010391:Pemphigoid, Bullous / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D012867:Skin / Q000473:pathology; D013997:Time Factors
D003176:Complement C3; D007070:Immunoglobulin A; D007074:Immunoglobulin G