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Bullous pemphigoid of childhood in Infant/Neonate
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Bullous pemphigoid of childhood in Infant/Neonate

Contributors: Erin X. Wei MD, John Zampella MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


This summary discusses pediatric patients. Bullous pemphigoid in adults is addressed separately.

Bullous pemphigoid is a chronic autoimmune subepidermal vesiculobullous disease that is most common in older adults. It is rarely seen in infants and children, in whom the precise incidence is unknown.

In the pediatric population, clinical presentation of bullous pemphigoid is variable, with ill-appearing patients who have severe, generalized blisters on one end of the spectrum and patients with localized, asymptomatic lesions on the other. As in adults, pruritic urticarial papules and plaques may precede the formation of bullae. Bullae can be widespread or localized on any body surface. In infants, palms and soles may predominate. Mucosal involvement in children is common.

Genital involvement is reported to occur in less than 50% of cases. Localized bullous pemphigoid of the genital skin is reported in children aged 7-12. Girls are affected more frequently than boys. When present, this condition can be misdiagnosed as child sexual abuse, and careful consideration must be taken in these cases.

The natural history of bullous pemphigoid in pediatric patients is not well characterized, but some have been reported to resolve within 1-2 years, while others have had a relapsing course.


L12.0 – Bullous pemphigoid

402439006 – Childhood bullous pemphigoid

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Differential Diagnosis & Pitfalls

  • Linear IgA bullous dermatosis of childhood – distinguished by immunofluorescence
  • Herpes simplex virus (HSV) infection – positive HSV polymerase chain reaction (PCR)
  • Bullous impetigo – classic yellow crusting and positive culture
  • Epidermolysis bullosa acquisita – distinguished on DIF of salt-split skin
  • Epidermolysis bullosa simplex – family history may be positive
  • Mucous membrane pemphigoid – heals with scarring
  • Dermatitis herpetiformis – may have associated diarrhea
  • Bullous Fixed drug eruption – history of drug exposure
  • Stevens-Johnson syndrome – histopathology makes distinction
  • Immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura) – may have joint or abdominal pain
  • Physical child abuse – look for atypical location of blisters, other signs of trauma, bruising
For localized genital involvement, also consider:
  • Bullous Arthropod bite or sting
  • Bullous Allergic contact dermatitis
  • Lichen sclerosus
  • Child sexual abuse
In infants, bullous pemphigoid may involve only the palms and soles and is in the differential diagnosis of all nontransient blistering lesions of childhood.

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Last Reviewed:03/01/2022
Last Updated:03/09/2022
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Bullous pemphigoid of childhood in Infant/Neonate
A medical illustration showing key findings of Bullous pemphigoid of childhood : Tense bullae, Pruritus, Tense vesicles
Clinical image of Bullous pemphigoid of childhood - imageId=2135869. Click to open in gallery.  caption: 'A bulla and some crusting and hypopigmented macules on the central face.'
A bulla and some crusting and hypopigmented macules on the central face.
Copyright © 2024 VisualDx®. All rights reserved.