Br J Dermatol. 2025 Dec 19;193(Supplement_3):ljaf465.019. doi: 10.1093/bjd/ljaf465.019.
ABSTRACT
Infantile bullous pemphigoid (IBP) usually presents at 3-5 months of age and resolves rapidly with appropriate therapy. Unfortunately, diagnosis and effective treatment are often delayed as in the case reported here. The paediatric dermatology team was called to the emergency department to see a 4-month-old girl with widespread tense vesicles, bullae and patchy erythema. The clinical diagnosis of IBP was confirmed by histology and direct immunofluorescence, and she was treated with erythromycin and prednisolone 0.5 mg/kg/day. Within 2 weeks all lesions were drying up and the steroid was discontinued after 8 weeks with no relapse. This child had first presented to the GP more than 3 weeks previously and as well as 3 GP visits had an admission to a paediatric ward with suspected hand, foot and mouth disease. Photographs were sent to the local dermatology team who advised treatment with flucloxacillin and acyclovir. She returned 2 days after discharge with continuing bullous lesions only to be reassured that it would settle in time. Three days later the GP referred her to Urgent Care and thence to our service. Although the diagnosis is straightforward for paediatric dermatologists, the rarity of IBP means that GPs and others may fail to recognize it and favor more common infectious diagnoses. It is likely that a paediatric dermatologist would recognize immune bullous disease even based on photographs. Faced with an unusual infantile rash, GPs and paediatricians should be encouraged to refer promptly, with photographs, to paediatric dermatologists who need to accommodate such referrals.
PMID:41412981 | DOI:10.1093/bjd/ljaf465.019