Development of a bullous pemphigoid after split-skin grafting

An elderly female patient developed blisters localised to her split-skin do nor and graft sites. Despite repeated swabs, bacteriology and virology retu rned negative; multiple antibiotic courses did not improve her condition, w hich generalised within weeks, Histology and immunofluorescence confirmed a clinical diagnosis of bullous pemphigoid and her condition resolved rapidl y after treatment with prednisolone. Bullous pemphigoid can be precipitated or exacerbated by surgery and the diagnosis should be considered when pati ents present with persistent localised or generalised blisters, especially when microbiological investigations are negative. (C) 2001 The British Asso ciation of Plastic Surgeons.