10.5826/dpc.1401a31
text/xml
2160-9381
3551
en
Emiliano Antiga
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Post-Surgical Anti-BP230 Bullous Pemphigoid: A Rare Cause of Non-Healing Wound
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2024-01-31
2023-05-19
2024-01-31
2024-02-21
e2024031
Dermatol Pract Concept
Emiliano Antiga
2024/01/31
10.5826/dpc.1401a31
e2024031
Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
2160-9381
en
e2024031
Ramcke T, Vicari E, Bolduan V, Enk A, Hadaschik E. Bullous pemphigoid (BP) patients with selective IgG autoreactivity against BP230: Review of a rare but valuable cohort with impact on the comprehension of the pathogenesis of BP. J Dermatol Sci. 2022;105(2):72-79. DOI: 10.1016/j.jdermsci.2021.11.011. PMID: 34930674.
Post-Surgical Anti-BP230 Bullous Pemphigoid: A Rare Cause of Non-Healing Wound
https://dpcj.org/index.php/dpc/article/download/3551/2565
        Post-Surgical Anti-BP230 Bullous Pemphigoid:
             A Rare Cause of Non-Healing Wound
      Carlo Pipitò1, Maria E Baffa1, Roberto Maglie1, Stefano Senatore1, Emiliano Antiga1


1 Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy



Citation: Pipitò C, Baffa ME, Maglie R, Senatore S, Antiga E. Post-Surgical Anti-BP230 Bullous Pemphigoid: A Rare Cause of Non-Healing
Wound. Dermatol Pract Concept. 2024;14(1):e2024031. DOI: https://doi.org/10.5826/dpc.1401a31
Accepted: May 31, 2023; Published: January 2024
Copyright: ©2024 Pipitò et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Carlo Pipitò, Department of Health Sciences, Section of Dermatology, University of Florence, Hospital Piero Palagi,
Viale Michelangiolo 41, 50125, Florence, Italy. E-mail: carlo.pipito@unifi.it




Case Presentation                                                        Teaching Point
A woman in her 80s presented with a 10-month history of                  Bullous pemphigoid is the most frequent autoimmune bul-
a nonhealing figurate erosive lesion that traces almost pre-             lous disease. In most cases, it presents with itch and tense
cisely the outline of the surgical abdominal scar following              blisters over erythematous and edematous skin [1]. Although
bowel resection performed one year earlier (Figure 1A). The              BP180 is the major autoantigen of bullous pemphigoid,
wound had not improved despite advanced wound care and                   some cases of patients having only anti-BP230 autoanti-
topical and systemic antibiotics. While the histological exam-           bodies have been reported yet. Interestingly, patients having
ination was unspecific, direct immunofluorescence revealed               bullous pemphigoid with only anti-BP230 autoantibodies
the presence of linear IgG and C3 deposits at the basement               usually show a more localized clinical involvement as well as
membrane zone. Moreover, an enzyme-linked immunosor-                     atypical clinical features; moreover, some of these cases are
bent assay was positive for IgG against BP230 (30 UI/mL:                 secondary to trauma [2]. In conclusion, bullous pemphigoid
reference value < 9 UI/ml), with no evidence of anti-BP180               should be considered as a differential diagnosis in patients
antibodies. Clinical and laboratory findings were compati-               with post-surgical wounds that do not heal with conven-
ble with the post-traumatic anti-BP230 bullous pemphigoid                tional wound care; in these patients, steroids usually lead to
diagnosis. The patient was treated with a tapering course                a prompt remission.
of oral prednisone at a starting dose of 0.5/mg/kg/die, with
rapid improvement of the condition (Figure 1B).




Image Letter | Dermatol Pract Concept. 2024;14(1):e2024031                                                                             1
            Figure 1. (A) Non-healing figurate erosive lesion that traces almost precisely the outline of the surgical
            ­abdominal scar following bowel resection. (B) Improvement of the lesion after one week.




References                                                             against BP230: Review of a rare but valuable cohort with im-
                                                                       pact on the comprehension of the pathogenesis of BP. J Dermatol
1. Schmidt E, Zillikens D. Pemphigoid diseases. Lancet. 2013;          Sci. 2022;105(2):72-79. DOI: 10.1016/j.jdermsci.2021.11.011.
   381(9863):320-332. DOI: 10.1016/S0140-6736(12)61140-4.              PMID: 34930674.
   PMID: 23237497.
2. Ramcke T, Vicari E, Bolduan V, Enk A, Hadaschik E. Bullous
   pemphigoid (BP) patients with selective IgG autoreactivity




2                                                                         Image Letter | Dermatol Pract Concept. 2024;14(1):e2024031
