Bullous Pemphigoid and Tetracycline

Abstract

An 85 year old female nursing home resident with a history of alcoholism, poorly controlled diabetes, hypertension and gout was brought to the dermatology clinic for a 6 month history of itchy skin and blisters. On exam, there were tense bullae on erythematous and normal appearing skin as well as urticarial, eroded and crusted plaques on the inner aspects of bilateral upper and lower extremities, and extensor surfaces of lower extremities (Fig. 3.1). Nikolsky’s sign was negative and the oral mucosa was clear. Her current medications include hydrochlorothiazide, lisinopril, glipizide, metformin and allopurinol. Two biopsies were performed. H&E showed subepidermal bullae with numerous eosinophils and rare neutrophils. No acantholysis. Direct immunofluorescence demonstrates linear IgG and C3 along the basement membrane. A diagnosis of bullous pemphigoid was made. What is the best management option for her?