To the Editor.—
Despite the unusual feature of scarring, the case reported by Trepanier1 may well be one of localized bullous dermatitis herpetiformis. Certainly its histopathology, chronicity, pruritus, and response to sulfone therapy speak for that diagnosis. I would not, however, eliminate the diagnosis of cicatricial pemphigoid because of the absence of basement zone antibodies on indirect immunofluorescent staining. The work showing the presence of such antibodies has been done with bullous pemphigoid, which, while sharing subepidermal bulla formation, is a different condition from cicatricial pemphigoid.A point of clinical distinction that may be useful in the differential diagnosis of cases similar to the one presented by Trepanier is the occurrence of milia in the scars of cicatricial pemphigoid and their absence in the healed areas of dermatitis herpetiformis. This is exemplified by a photograph that accompanies the report2 in the "Society Transactions" of a patient with cicatricial
Cohen HJ. BULLOUS DERMATITIS HERPETIFORMIS. Arch Dermatol. 1970;101(4):485. doi:10.1001/archderm.1970.04000040107025
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