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Severe bullous pemphigoid with excoriation disorder
  1. Kaitlin McGowan1,
  2. Stephen Poos1 and
  3. Nguyen Vo2
  1. 1Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
  2. 2Hackensack Meridian Ocean University Medical Center Pathology Department, Brick, New Jersey, USA
  1. Correspondence to Ms Kaitlin McGowan; mcgowa47{at}


Bullous pemphigoid is the most common autoimmune blistering skin disease. Pathogenesis involves autoantibodies that attack the basement membrane, resulting in blisters and intense pruritus. We present a case of bullous pemphigoid with concurrent excoriation disorder in a woman in her 50s. The suspected diagnosis of bullous pemphigoid was confirmed through direct immunofluorescence testing on a specimen obtained via punch biopsy, then treated with vancomycin and steroids. In addition, cross tapering from duloxetine to fluoxetine was used to treat the patient’s excoriation disorder. The concurrent dermatological and psychiatric components, as well as the severity, made this case unique.

  • Dermatology
  • Psychiatry (drugs and medicines)
  • Immunology
  • Pathology
  • Impulse control disorders

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  • Contributors KM and SP conceived of the presented case report. NV handled pathology specimens and pathology interpretation. KM and SP wrote all of the manuscript with the exception of the pathology section written by NV. As the fully practising physician involved in the case, NV helped supervise the project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.