Two cases of pemphigoid nodularis

We report two cases of pemphigoid nodularis with anti-BP180 antibody and prurigo-like nodules preceding the development of blisters. Case 1 : A 62-year-old woman with a 2-year history of pruritic nodules on her trunk, extremities, and head, which had been treated as prurigo nodularis, developed blisters on her thighs. She was diagnosed as having pemphigoid nodularis, based on results that included increased titer of serum anti-BP180 antibody (ELISA), histopathology, and direct and indirect immunofluorescence. The blisters cleared after treatment with oral prednisolone (5 mg/day) and minocycline (150 mg/day) but recurred duringthe taperingof the dose of minocycline. After the prednisolone dose was raised to 15 mg/day, the nodules quickly improved. Case 2 : In March 2007, a 55-year-old woman had pruritic nodules on the upper extremities, which gradually extended to the entire body. She had been resistant to treatment with topical steroids and narrow band UVB under the initial diagnosis of prurigo nodularis, while blisters appeared on the extremities in June 2007. After the diagnosis of pemphigoid nodularis was made, treatment with oral prednisolone (25 mg/day) and minocycline (100 mg/day) was initiated, which resulted in clearance of the blisters. When the blisters recurred in April 2010, oral prednisolone (50 mg/day) cleared the blisters. However, because severe pruritus and nodules remained, prednisolone was exchanged for betamethasone, leadingto a partial resolution. Consideringthe previous reports, pruritic nodules appear first and blisters develop later in many cases. When clinical manifestations consist only of pruritic nodules, anti-BP180 antibody (ELISA) and immunofluorescence are valuable tools to diagnose pemphigoid nodularis.