Metastatic colonic adenocarcinoma to the glans penis.
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Biomedical subjects
Publications and source records attributed to G G Gruber.
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The vesicular variant of bullous pemphigoid (BP) is a clinical entity in which the principal types of lesions are multiple small tense vesicles in a symmetric distribution, rather than large, more randomly distributed bullae. We present a patient who developed an intensely pruritic eruption which clinically was suggestive of typical dermatitis herpetiformis (DH), but subsequently developed large bullae typical of BP. Histologic and immunofluorescence findings, as well as initial response to systemic corticosteroids, were typical of BP. In addition, our patient required the administration of methotrexate to maintain clearance of lesions while prednisone was being tapered, a problem which has not been mentioned in the other patients, described in the literature with vesicular variants of BP.
Methotrexate is widely used by dermatologists in the treatment of recalcitrant psoriasis. Despite potentially serious side effects, including hepatic cirrhosis, the drug is relatively safe and remarkably effective when carefully administered to selected patients.
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Systemic complications of drugs commonly prescribed by dermatologists fortunately are uncommon. Nevertheless, it is extremely important that the dermatologist be aware of medical contraindications to the use of these agents, as well as their potential systemic side effects. These considerations for methotrexate, sulfones, tetracyclines, and corticosteroids are reviewed.
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