INTRODUCTION
Bullous pemphigoid (BP) is a chronic, autoimmune subepidermal blistering disease typically presenting with widespread urticarial plaques, blisters, and pruritus. Localized variants of BP, such as peristomal, have been rarely reported in the literature.1-5 Herein, we report a case of peristomal BP that emerged after a colostomy. This case highlights the potential role of the Koebner phenomenon in the etiology and pathophysiology of peristomal BP.
CASE REPORT
A 70-year-old female with a history of dyshidrotic eczema, breast cancer, and diverticulitis presented to the dermatology clinic for a peristomal eruption that developed four months after a Hartmann procedure was performed for perforated diverticulitis. Examination of the abdomen revealed erythema, tense blisters, a rim of fine vesicles around the ostomy, and peristomal erosions (Figure 1). There were no other blisters present on cutaneous exam, other than palmoplantar, tense bullae, previously diagnosed as dyshidrotic eczema.
A punch biopsy was performed and demonstrated an intraepidermal vesicular mixed-cell infiltrate with eosinophils and gram-positive cocci, suggestive of acute allergic contact dermatitis with co-occurring Staphylococcus aureus superinfection. The patient improved after a short course of oral antibiotics and topical steroids but subsequently flared.
