Non-bullous lesions as the first manifestation of bullous pemphigoid: A retrospective analysis of 24 cases

Objective: To explore the clinical features, laboratory findings and therapy of the patients with bullous pemphigoid initially manifested as non-bullous lesions. Methods: The medical records of 24 cases of bullous pemphigoid initially manifested as non-bullous lesions were retrospectively analyzed. Results: The male–female ratio was 2:1. The mean age of first onset was 61.71 ± 15.82 years old. The patients presented with erythema, papules, papulovesicles, plaques, wheals, nodules or erythema multiform-like lesions before typical bullae appeared. The majority of the initial lesions were concurrent erythema, papules and plaques (11/24, 45.83%). The first blisters were located on the extremities in eight patients (33.33%). A limitation of the study was not being able to analyze the histopathological and immunopathological features of the initial non-bullous lesions as it was a retrospective study. Conclusions: Nearly one-third of patients with bullous pemphigoid presented with multiform initial lesions, mainly erythema, papules and plaques simultaneously before the first blisters appeared. The extremities are the favorite sites of the first blisters. The diagnosis was confirmed by histopathology and immunofluorescence.