Vaillant et al identified a number of clinical criteria which can be helpful in the diagnosis of bullous pemphigoid. The authors are from the French Bullous Study Group.
Patient selection: adult with bullous skin lesions
(1) age in years
(2) atrophic scars
(3) involvement of head and neck
(4) involvement of mucosa
age in years
<= 70 years
> 70 years
involvement of head and neck
total score =
= SUM(points for all 4 parameters)
• minimum score: 0
• maximum score: 4
• A score >= 3 is associated with bullous pemphigoid.
• At a cutoff of >= 3 the sensitivity was 90% and specificity 83%.
• The positive predictive value was 95%.
Other factors associated with bullous pemphigoid identified:
(1) erythematous plaques
(2) absence of milia
(3) hypereosinophilia (absolute eosinophil count > 500 per µL)
(4) serum anti-BMZ antibodies
(5) absence of mechanical blisters
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