Secondary Cicatricial Scalp Alopecia Caused by Brunsting-Perry Pemphigoid: A Case Report

TL;DR

This case report describes a rare skin condition, Brunsting-Perry pemphigoid, that caused scarring hair loss on the scalp and was successfully treated with corticosteroids.

Contribution

The paper highlights the underdiagnosis of Brunsting-Perry pemphigoid as a cause of scarring alopecia.

Findings

Brunsting-Perry pemphigoid can present as long-standing cicatricial alopecia with characteristic dermoscopic features.

Intralesional betamethasone and topical corticosteroids effectively managed the condition in the reported case.

Immunopathology confirmed the diagnosis with specific antibody deposits along the basement membrane.

Abstract

Brunsting-Perry pemphigoid is a rare, chronically persistent bullous dermatosis, localized to the head, scalp, and neck, causing residual scars and cicatricial alopecia. Herein, we present a case of Brunsting-Perry pemphigoid in a 68-year-old Caucasian woman presenting with over 10 years of history of slowly progressing patchy cicatricial alopecia. Dermoscopy showed scarring, a milky red background, and a typical picture of a “fried-egg sign” representing specific follicular damage. A skin biopsy revealed a subepidermal blister with dermal inflammation. Immunopathology shows strong linear continuous deposits of C3c and IgM along the basement membrane, and moderate to weak linear reactions to IgG and IgA. Intralesional betamethasone was successful in the treatment, and topical mometasone furoate lotion was used to maintain the result. Our case suggests that Brunsting-Perry pemphigoid may be underdiagnosed as the reason for scarring alopecia, considering the scarce information about the disease in the literature.

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