Dyshidrosiform pemphigoid: a well-defined clinical entity?

DP is a term first used by Levine et al. in 1979 to define a rare localized form of bullous pemphigoid (BP), characterized by subepidermal blisters on the palmoplantar areas [1]. We criticize the use of this term, since the 29 cases of DP described to date have presented different clinical courses. On reviewing them, we found that the vesiculobullae arose and remained localized on the palmoplantar area, as the only manifestation of the disease, in only 8 patients (group I), while in 7 cases the palmoplantar blisters preceded a classic BP eruption on the rest of the body by weeks or months (group II), and in 14 cases the palmoplantar lesions appeared concomitantly with a generalized bullous eruption (group III). Furthermore, considering that localized pemphigoid is a form of BP, which is limited to a specific cutaneous area, with possible secondary spreading to the rest of the tegument, we suggest that a proper diagnosis of DP may be applied only to group I and II patients. Group III patients may be described as being affected by BP with palmoplantar involvement, which is not rare, particularly in paediatric patients