To the Editor.—
The paper by Eng and Moncada1 is a clear presentation of the problem of histologic differentiation between bullous pemphigoid (BP) and dermatitis herpetiformis. Unfortunately, the tabulated criteria for diagnosis further potentiate, without adequate substantiation, the erroneous concept that if it responds to sulfapyridine or dapsone, it isn't pemphigoid. In a recent review of the Mayo Clinic experience with BP,2 it was noted that a number of these patients were satisfactorily treated with sulfapyridine and a few with dapsone. These drugs are not as uniformly effective in BP as are the corticosteroids, but in view of the relative complications and side effects, the former drugs definitely deserve a trial. A satisfactory response to sulfapyridine or dapsone should never be construed as evidence negating the diagnosis of BP.
Stone SP. Bullous Pemphigoid. Arch Dermatol. 1974;110(5):812. doi:10.1001/archderm.1974.01630110090038