{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:40:03Z","timestamp":1756323603013,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,8,23]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>Bullous pemphigoid is the most common autoimmune blistering skin disease. Pathogenesis involves autoantibodies that attack the basement membrane, resulting in blisters and intense pruritus. We present a case of bullous pemphigoid with concurrent excoriation disorder in a woman in her 50s. The suspected diagnosis of bullous pemphigoid was confirmed through direct immunofluorescence testing on a specimen obtained via punch biopsy, then treated with vancomycin and steroids. In addition, cross tapering from duloxetine to fluoxetine was used to treat the patient\u2019s excoriation disorder. The concurrent dermatological and psychiatric components, as well as the severity, made this case unique.<\/jats:p>","DOI":"10.1136\/bcr-2022-250285","type":"journal-article","created":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T12:05:45Z","timestamp":1662379545000},"page":"e250285","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Severe bullous pemphigoid with excoriation disorder"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9206-974X","authenticated-orcid":false,"given":"Kaitlin","family":"McGowan","sequence":"first","affiliation":[{"name":"Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Poos","sequence":"additional","affiliation":[{"name":"Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nguyen","family":"Vo","sequence":"additional","affiliation":[{"name":"Hackensack Meridian Ocean University Medical Center Pathology Department, Brick, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,9,5]]},"reference":[{"key":"2025082711574987000_15.9.e250285.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61140-4"},{"key":"2025082711574987000_15.9.e250285.2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1590\/abd1806-4841.20199007","article-title":"Bullous pemphigoid","volume":"94","author":"Miyamoto","year":"2019","journal-title":"An Bras Dermatol"},{"key":"2025082711574987000_15.9.e250285.3","first-page":"508","article-title":"Bullous pemphigoid presenting as generalized pruritus: observations in six patients","volume":"37","author":"Alonso-Llamazares","year":"1998","journal-title":"Int J Dermatol"},{"key":"2025082711574987000_15.9.e250285.4","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jpsychires.2020.06.033","article-title":"Prevalence of skin Picking (excoriation) disorder","volume":"130","author":"Grant","year":"2020","journal-title":"J Psychiatr Res"},{"key":"2025082711574987000_15.9.e250285.5","unstructured":"American Psychiatric Association . Excoriation (skin-picking) disorder. In: The diagnostic and statistical manual of mental disorders. 5th. 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