Bullous pemphigoid and burns: the unveiling of the attachment plaque?

Two patients with bullous pemphigoid (BP) associated with burns are described. The case with BP lesions that were localized is the first to be described in the literature and generalized BP has been described on only one occasion previously. Both cases exhibited the clinical features of BP and settled with the use of oral prednisolone. Many extrinsic precipitants of BP have been described; however, the precise trigger of the autoimmune process is not yet understood. The authors discuss the hypothesis that as burns expose BP antigen, the association of BP with advancing years arises through exposure of BP antigen during the process of involution of the basement membrane zone seen in the normal process of ageing. BP should be considered in cases of burns associated blistering, particularly blisters occurring at distant sites, but also involving affected skin.