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Year : 2011  |  Volume : 2  |  Issue : 1  |  Page : 36-37  

Perifollicular pigmentation in bullous pemphigoid: A diagnostic sign


Department of Dermatology, PSG Hospitals, Peelamedu, Coimbatore, India

Date of Web Publication21-Apr-2011

Correspondence Address:
M Kumaresan
Department of Dermatology, PSG Hospitals, Peelamedu, Coimbatore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.79862

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How to cite this article:
Kumaresan M, Srinivas C R. Perifollicular pigmentation in bullous pemphigoid: A diagnostic sign. Indian Dermatol Online J 2011;2:36-7

How to cite this URL:
Kumaresan M, Srinivas C R. Perifollicular pigmentation in bullous pemphigoid: A diagnostic sign. Indian Dermatol Online J [serial online] 2011 [cited 2019 Apr 20];2:36-7. Available from: http://www.idoj.in/text.asp?2011/2/1/36/79862

Sir,

One of the earliest lessons the post graduate students in dermatology learns is to clinically differentiate between pemphigus and bullous pemphigoid (BP). The differentiating points include nature of blisters?tense/flaccid, mucosal involvement, Nikolsky sign, Bulla spread sign, and tendency of the erosion to spread after rupture. [1],[2],[3],[4],[5] We have observed a difference in the character of repigmentation during healing stage of pemphigus and pemphigoid. In pemphigus the pigmentation is more diffuse [Figure 1], whereas in BP during the healing stage there is prominence of hair follicles which appears as tiny raised papules over the raw areas followed by follicular pigmentation [Figure 2] and [Figure 3] which subsequently becomes diffuse. We also observed that postinflammatory pigmentation is relatively more intense in BP.
Figure 1: Diffuse pigmentation in pemphigus

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Figure 2: Perifollicular pigmentation

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Figure 3: Perifollicular pigmentation

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The diffuse pigmentation in pemphigus is possibly due to repigmentation of the intact melanocytes in the basal layer, which is not lost during the disease process. Whereas in BP, there is complete loss of epidermis with partial loss of basement membrane. Thus basal cells are lost in the disease process. Following treatment during healing phase the pigmentation has to appear either from the margin centripetally or from the appendages. Our observation suggests that the appendages play a major role in healing phase of BP and the presence of follicular pigmentation in the erosions suggests the diagnosis of bullous pemphigoid.

 
   References Top

1.Korfitis C, Gregorioul S, Georgala S, Christofidou E, Danopoulou I. Trauma-induced bullous pemphigoid. Indian J Derm Venereol Leprol 2009;75:617-9.  Back to cited text no. 1
    
2.Odom RB, James WD, Berger TG. Andrews' Diseases of the skin. 9 th ed. Philadelphia: WB Saunders; 2000. p. 574-605.   Back to cited text no. 2
    
3.Grando SA, Grando AA, Glukhenky BT, Doguzov V, Nguyen VT, Holubar K. History and clinical significance of mechanical symptoms in blistering dermatoses: A reappraisal. J Am Acad Dermatol 2003;48:86-92.   Back to cited text no. 3
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4.Arya SR, Valand AG, Krishna K. A clinico-pathological study of 70 cases of pemphigus. Indian J Derm Venereol Leprol 1999;66;168-71.  Back to cited text no. 4
    
5.Vaishnani JB, Bosamiya SS. Pemphigus: Active or inactive? Indian J Drmatol 2009;54:186-8.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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