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Bullous pemphigoid (BP) disproportionately affects the elderly with an incidence between 2.3 and 23 per million people nationally. Mucosal involvement is infrequent with ocular manifestations even rarer (estimated to affect 1 in 8000 to 1 in 46000 patients). This unique case highlights unusual side effects of complex therapies for BP.

Contact Dermatitis is an inflammatory skin disorder that occurs after contact with an irritant or allergen. Patch testing (PT) is the gold standard procedure for diagnosing allergic contact dermatitis (ACD) and identifying clinically relevant allergens. The North American Contact Dermatitis Group (NACDG) recently published the most common allergens identified in 2019-2020, which includes nickel, methylisothiazolinone (MI), fragrance mix (FM) I, hydroperoxides of linalool (HPL), and benzisothiazolinone (BIT).

Common Variable Immunodeficiency (CVID) is associated with a higher risk of malignancy compared to the general population. Immunoglobulin replacement therapy has improved the life expectancy of CVID patients, leading to a greater prevalence of malignancy. Although primary cancers in CVID are well established, a second malignancy on a transplanted liver is a more rare presentation.

Drug reaction with eosinophilia and systemic symptoms (DRESS)/drug-induced hypersensitivity syndrome (DIHS) represents a severe adverse drug reaction with a high mortality rate. Allopurinol-induced DRESS/DIHS can be associated with polymorphisms in human leukocyte antigen (HLA) genes, with higher prevalence of the HLA-B*58:01 allele in Asians (7.4%) and Africans (3.8%) compared to other ethnic populations.

Mycosis fungoides (MF) is the most common form of primary cutaneous T-cell lymphomas, characterized by a long clinical course and malignant T-cell proliferation. The early stages of MF can mimic atopic dermatitis (AD), and psoriasis and thus, diagnosis can be challenging and oftentimes delayed.

While IgE-mediated hypersensitivity to COVID-19 vaccines may occur, many adverse reactions (ARs) to COVID-19 vaccination are non-immunologic in nature and meet criteria for immunization stress-related response (ISRR).

The possibility that the distribution of skin lesions in some cutaneous diseases is due to variations in the antigenic properties of skin was investigated by mapping the expression of the skin-specific pemphigus vulgaris and bullous pemphigoid antigens in different regions of the body. The expression of both antigens was relatively stable within the same region, but varied between regions in a pattern that was distinct for each antigen. For each antigen there was a correlation between regions of high expression and location of skin lesions in autoimmune diseases involving the antigen. The results indicate that there are marked regional differences in the antigenic properties of skin and suggest this may influence the distribution of cutaneous lesions in some skin diseases.

Failure to recognize anaphylaxis or delayed epinephrine auto-injector (EAI) administration may result in poor patient outcomes.  Clinical simulation is an educational method used for environment-controlled, team-based learning.

Penicillin skin testing (ST) followed by an oral challenge remains the standard of care to remove the label of penicillin allergy. Despite a negative penicillin allergy evaluation, studies have shown persistence/re-documentation of penicillin allergy upon further follow-up.