Flame figures associated with bullous pemphigoid.

We report a case of bullous pemphigoid showing the histological features of flame figures. An 80-year-old man was admitted with multiple, tense, thumb-sized blisters among erythematous plaques on his trunk and limbs. A biopsy showed accumulations of eosinophil granules on the collagen fibers, forming characteristic "flame figures", in addition to the features of bullous pemphigoid. We retrospectively examined biopsy specimens from 34 patients with bullous pemphigoid treated in our department over the last 10 years for the presence of flame figures. They were observed in 3 of these patients (8.8%), all of whom were more than 80 years of age. Our retrospective study indicates that the association of flame figures with bullous pemphigoid is not rare, considering the fact that the present case is only the third report of this association. Our data also suggest that the degree of dermal eosinophilia and the formation of flame figures could be related.