Mucous membrane pemphigoid of the vulva.
BACKGROUND
Mucous membrane pemphigoid is a rare autoimmune blistering disease primarily affecting mucosal surfaces. Blistering and scarring may occur in the eyes, mouth, esophagus, larynx, and on the vulva. Scarring can result in severe structural changes to the vulva that may mimic the findings of other inflammatory dermatologic disorders of the vulva, including lichen sclerosus and lichen planus.


METHODS
A 58-year-old woman presented with vulvar erosions, esophagitis, and laryngeal blisters. The clinical picture and the histopathology of a vulvar biopsy were suggestive of erosive lichen planus. Direct immunofluorescence, however, revealed findings diagnostic of mucous membrane pemphigoid.


CONCLUSIONS
This case illustrates the importance of examining extragenital mucosal surfaces of any woman presenting with vulvar lesions. In addition, it demonstrates the importance of vulvar biopsy and the usefulness of direct immunofluorescence to differentiate between conditions with similar clinical and histopathologic changes.
Goldstein
Andrew T
AT
Division of Gynecologic Specialties and Department of Dermatology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA. obstetrics@yahoo.com
Anhalt
Grant J
GJ
Klingman
Daisy
D
Burrows
Lara J
LJ
D001707:Biopsy, Needle; D004359:Drug Therapy, Combination; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010390:Pemphigoid, Benign Mucous Membrane / Q000175:diagnosis* / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014845:Vulvar Diseases / Q000175:diagnosis* / Q000188:drug therapy*
D009173:Mycophenolic Acid; D011241:Prednisone