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Case 27: Male 22 yrs. 4 wks H/O generalized eruption with erosions and blisters on arms and legs.
• Bullous lichen planus• Lichen planus
pemphigoides• Lichenoid drug eruption• Bullous pemphigoid
IgG
Case 27: Diagnosis
• Bullous lichen planus
• Lichenoid drug eruption
• Lichen planus pemphigoides
• Bullous pemphigoid
Lichen planus pemphigoides
• Rare condition (<100 reported cases) (Kaposi 1892).
• Young adults generally affected, M>F, usually idiopathic –some drug related and paraneoplastic.
• Lichenoid eruption > blisters.
• Blisters develop on normal / erythematous skin or lichenoid areas.
• Epitope sharing: dense lichenoid inflammation > exposure of BMZ antigens> circulating autoantibodies.
• Combination of lichenoid interface dermatitis and subepidermal vesiculobullous dermatitis but variable.
• Some cases show cell poor subepidermal blisters with LP like changes at the periphery.
• Immunofluorescence profile similar to BP.
Lichen planus pemphigoides
Case 27: Differential diagnosis
• Bullous lichen planus
• Lichenoid drug eruption
• Lichen planus pemphigoides
• Bullous pemphigoid
Lichen planus pemphigoides: learning points
• Consider as a possibility when a subepidermal blisters develops in the context of a lichenoid interface dermatitis.
• Correlation with the clinical presentation and immunofluorescence profile may be needed to differentiate LPP from paraneoplastic pemphigoid.
• Prognosis and response to treatment much better than bullous pemphigoid.
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