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

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.