Localized Bullous Pemphigoid of the Scalp and Face with Suspected Vulvar Involvement: A Case Report

Background

Localized bullous pemphigoid (LBP) is a form of bullous pemphigoid (BP) confined to a limited anatomical area. Classification becomes less certain when clinically similar lesions occur at a distant site without site-specific immunopathologic confirmation. We report immunopathologically supported scalp/facial BP-spectrum disease with a temporally associated but unconfirmed vulvar eruption. Case Presentation: A 51-year-old woman presented with a 3-month history of pruritic erythema and tense bullae on the scalp and face and a 1-month history of erythematous scaly plaques with hemorrhagic bullous lesions in the vulvar region. Scalp histopathology showed a subepidermal blister with eosinophil-rich inflammation, and direct immunofluorescence (DIF) of perilesional scalp skin showed linear IgG and C3 deposition along the basement membrane zone. Infectious studies of the vulvar eruption were negative. Anti-BP180/230 serology, indirect immunofluorescence, salt-split skin studies, and anti-type VII collagen antibody testing were unavailable. Vulvar biopsy and DIF were not performed; therefore, vulvar BP could not be confirmed. With systemic and topical corticosteroids plus adjunctive minocycline, no new bullae developed by day 5, and the lesions markedly improved within 2 weeks. Methylprednisolone was subsequently tapered from 40 mg/day to a maintenance dose of 4 mg/day; minocycline and topical corticosteroids were discontinued after sustained clinical improvement. At 6 months, the disease remained clinically controlled on methylprednisolone 4 mg/day, with no new bullae or clinically evident recurrence. No treatment-related adverse events were observed.