Clinical variations in bullous pemphigoid with respect to early symptoms.

We report the clinical variations and the duration of prodromal symptoms in 20 patients with bullous pemphigoid. Nearly two-thirds of the patients had prodromal symptoms. THe duration of the prodromal eruptions was up to 6 weeks if papular and/or urticarial and up to 2 years if eczematous, before the blisters appeared. Evidently longer prodromal periods were found in the present study than in earlier investigations. It is not known when in the course of the disease the direct immunofluorescence will be positive. Two of our patients were immunofluorescence-positive 1 and 2 weeks respectively before the blisters appeared. A common clinical manifestation in this study was vesicles on palms and/or soles. These eruptions, particularly as an early symptom, may cause misinterpretation in patients with bullous pemphigoid.