Explosive bullous pemphigoid with high serum total IgE: Serum IgE as a biomarker that reflects disease activity

Bullous pemphigoid (BP) is a chronic autoimmune blistering disease characterized by pruritic, tense bullae and urticarial plaques. BP is associated with significant mortality, with 1-, 2-, and 5-year mortality rates of 19.46%, 29.13%, and 58.03%, respectively, in South Korea.1 The main pathogenesis involves IgG autoantibodies against hemidesmosomal proteins: BP 180 and BP 230. IgE autoantibodies are increasingly reported in BP.2 Herein we report a case of refractory BP with a fatal outcome and discuss the possible relationship between total serum IgE and disease activity.