CASE PRESENTATION
A 55-year-old female with a history of hypertension and discoid lupus presented to dermatology clinic with widespread urticated tense bullae and crusted erosions present for several months (Figure 1), consistent with bullous pemphigoid on further tissue and serological evaluation. Treatment was initiated with a prolonged prednisone taper, starting at 1 mg/kg, in conjunction with mycophenolate mofetil at a dose of 1 g daily. Although well-controlled initially, breakthrough blistering was noted approximately 6 months into the treatment course. At that time, the risks and benefits of the off-label use of rituximab for bullous pemphigoid was discussed,1-2 and patient elected to proceed with rituximab treatment.
The patient presented in follow up one month after completing two loading doses of rituximab 1,000 mg IV spaced two weeks apart with subsequent complete resolution of blistering and pruritus. Over the next few months, she developed progressive and eventually complete non-scarring alopecia involving the scalp, eyebrows, and eyelashes. Of note, our patient did have a background of previous scattered atrophic cicatricial alopecic plaques involving the scalp in areas of discoid lupus involvement (Figure 2). Biopsy obtained from an area of scarring on the scalp demonstrated features consistent with her known
The patient presented in follow up one month after completing two loading doses of rituximab 1,000 mg IV spaced two weeks apart with subsequent complete resolution of blistering and pruritus. Over the next few months, she developed progressive and eventually complete non-scarring alopecia involving the scalp, eyebrows, and eyelashes. Of note, our patient did have a background of previous scattered atrophic cicatricial alopecic plaques involving the scalp in areas of discoid lupus involvement (Figure 2). Biopsy obtained from an area of scarring on the scalp demonstrated features consistent with her known
