Bullous pemphigoid in a farmer. Medical photograph.

Abstract

Bullous pemphigoid (BP) is the most prevalent autoimmune blistering dermatosis, with an estimated incidence of 6 to 13 cases per million individuals in the United States [1]. BP predominantly affects patients over the age of 60, establishing advanced age as a significant predisposing factor. Other potential triggers for its pathogenesis include viral infections, ultraviolet radiation exposure, and contact with environmental irritants [2]. We present the case of a 69-year-old male farmer with a 71-day clinical course characterized by erythematous, urticarial plaques with irregular borders. The physical examination revealed tense vesicles and bullae containing serous fluid, interspersed with hemorrhagic crusts secondary to excoriation and focal areas of lichenification. Diagnosis was confirmed via histopathological analysis of a punch biopsy from both the bulla and the perilesional skin, consistent with a definitive diagnosis of autoimmune bullous pemphigoid.