Bullous pemphigoid

QUESTION 10

A 74-year-old man with a history of congestive heart failure presents to the emergency department with an itchy rash with blisters on his trunk and arms. He reports that he has had a 2-month history of intractable pruritus prior to the formation of blisters. He had been evaluated initially by his family practitioner with non-specific skin findings including scattered urticarial papules, eczema and associated excoriations. He had been treated empirically for scabies with permethrin 5% cream without improvement. On examination, there are multiple excoriated scaly papules and plaques, and several tense bullae on the trunk and arms (10a, b). A complete blood count (CBC) reveals peripheral eosinophilia.