Autoimmune bullous disease in skin of color: A case series
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Patients with nonwhite skin tones are underrepresented in the dermatologic literature and broader educational resources, a deficiency that is particularly problematic for rare disorders like autoimmune bullous diseases.

Case 1: An 82-year-old African-American woman presented with a painful blistering eruption that began on her hands, abdomen, and extremities without mucosal erosions. Physical examination found tense bullae on the extremities and trunk lacking appreciable erythema and large abdominal erosions. Histopathology, immunofluorescence, and enzyme-linked immunosorbent assay (ELISA) confirmed a diagnosis of bullous pemphigoid (BP). The patient was treated with clobetasol cream, a tapering course of prednisone, and mycophenolate. After 2 months, she achieved near-total healing of erosions but had residual hypopigmentation and perifollicular repigmentation.

Case 2: A 62-year-old Filipino man with a hematopoietic stem cell transplant for chronic leukemia presented with painful oral erosions and a pruritic blistering eruption on the trunk and extremities when tapering oral tacrolimus, used for graft-versus-host disease (GVHD) prophylaxis. Physical examination found urticarial plaques on the arms and trunk with peripheral vesicles and central hyperpigmentation ; shallow erosions were noted on the buccal mucosa. Biopsy, immunofluorescence, and ELISA were consistent with BP. The patient was treated with betamethasone ointment, dexamethasone mouthwash, doxycycline, and a tapering course of prednisone with rapid improvement.

Case 3: A 63-year-old African-American man with psoriasis treated with secukinumab for 3 years presented with a new pruritic blistering eruption, oral erosions, and odynophagia. Physical examination found erosions and tense bullae on the trunk and extremities; shallow oral erosions were noted on the buccal mucosa. The patient was treated with prednisone and mycophenolate, which induced remission. After his erosions healed, postinflammatory hyperpigmentation developed, which lasted more than 1 year.

Case 4: A 50-year-old African-American man with treated chronic hepatitis B virus (HBV) infection and latent tuberculosis presented with painful crusted lesions on the scalp, face, and trunk without mucosal erosions. Physical examination found eroded and crusted plaques and hyperpigmented patches on the scalp, face, trunk, and arms. The patient was treated with triamcinolone ointment, a tapering course of prednisone, and intralesional triamcinolone for recalcitrant scalp lesions. He experienced mild flares every few weeks controlled with triamcinolone. However, he had persistent postinflammatory hyperpigmentation at sites of healed lesions.

To ensure physicians and other clinicians are competent to diagnose and treat conditions in people with skin of color, increased diversity in clinical images used for training and continuing medical education is essential. Representing the full spectrum of skin tones can be challenging for rare disorders like AIBD.

Source: https://www.jaadcasereports.org/article/S2352-5126(20)30645-7/fulltext
Like
Comment
Share