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Formation of millium after bullous pemphigoid (BP)
is not so rare, but the cases presenting numerous number of milia like our case
is rare. We report a 70-year-old male who developed a remarkable number a
millium after BP improved. The number of
millium in our case might be more than previous reports. One of the cause of a remarkable number of
millium appeared in our case might be his chronic clinical course. In his 6 months of hospitalization, erythema,
blister and erosion relapsed many times over.
Every time erosions cured, keratin might be entrapped, and it might lead
a remarkable number of milia.
CASE REPORT
A 70-year-old male was referred to
our department, complaining of generalized blisters and erosions. He had been suspected of bullous pemphigoid
(BP) and treated with oral prednisolone (PSL) (30 mg/day), however, his
eruptions got worsened. Physical
examination revealed erythema and a number of scattered, tense blisters and
erosions on the trunk and extremities (Figure 1). Laboratory data by ELISA showed elevated
anti-BP180 antibody titer (2040; normal < 9). A biopsy specimen taken from
blister showed subepidermal bulla, and inflammatory cell infiltration, mainly
composed of eosinophils (Figure 2).
Direct immunofluorescence showed linear deposit of IgG in epidermal side
of dermo-epidermal junction (Figure 3).
We treated him with immunosuppressant (ciclosporin and methotrexate),
and plasma exchange in addition to oral PSL.
Erosions and blisters were slowly cured.
After erosions were cured, a numbers of milium-like eruptions that was
more than 100 appeared scattered on trunk and extremities (Figure 4, 5). A biopsy
specimen showed a cystic nodule with epithelial wall. The border of nodules was
clear, and lumen of the cyst was filled with keratin (Figure 6).
DISCUSSION
Formation
of millium after BP is not so rare, but the cases presenting numerous number of
milia like our case is rare. In a recent literature, Tsuruta et al. reported
multiple large milia appeared on BP patients [2]. In our case, remarkable
number of millium appeared, and it might be more than previous reports. One of
the cause of remarkable number of millium appeared in our case might be his
chronic clinical course. In his 6 months
of hospitalization, erythema, blister and erosion relapsed many times over. Every time erosions cured, keratin might be
entrapped, and it might lead remarkable number of milia. However there may be other causes of multiple
milia formation, and further studies are necessary.
REFERENCES
1. Hisa T, Goto Y, Taniguchi S, Nakanishi T,
Kakudo K, Takigawa M (1996) Post-bullous milia. Australas J Dermatol 37: 153-154.
2. Tsuruta D,
Brzezinski P, Koga H, Ohata C, Furumura M, Hashimoto T (2013) Bullous
pemphigoid with prominent milium formation.Acta Dermatovenerol Croat 21: 35-38.
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