Indian Dermatology Online Journal

MUSINGS/OPINIONS AND EXPERIENCES/TIPS AND TRICKS
Year
: 2011  |  Volume : 2  |  Issue : 1  |  Page : 36--37

Perifollicular pigmentation in bullous pemphigoid: A diagnostic sign


M Kumaresan, CR Srinivas 
 Department of Dermatology, PSG Hospitals, Peelamedu, Coimbatore, India

Correspondence Address:
M Kumaresan
Department of Dermatology, PSG Hospitals, Peelamedu, Coimbatore
India




How to cite this article:
Kumaresan M, Srinivas C R. Perifollicular pigmentation in bullous pemphigoid: A diagnostic sign.Indian Dermatol Online J 2011;2:36-37


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 2020 Jan 19 ];2:36-37
Available from: http://www.idoj.in/text.asp?2011/2/1/36/79862


Full Text

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}{Figure 2}{Figure 3}

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

1Korfitis C, Gregorioul S, Georgala S, Christofidou E, Danopoulou I. Trauma-induced bullous pemphigoid. Indian J Derm Venereol Leprol 2009;75:617-9.
2Odom RB, James WD, Berger TG. Andrews' Diseases of the skin. 9 th ed. Philadelphia: WB Saunders; 2000. p. 574-605.
3Grando 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.
4Arya SR, Valand AG, Krishna K. A clinico-pathological study of 70 cases of pemphigus. Indian J Derm Venereol Leprol 1999;66;168-71.
5Vaishnani JB, Bosamiya SS. Pemphigus: Active or inactive? Indian J Drmatol 2009;54:186-8.