Etanercept-induced generalization of chronic, localized, anogenital bullous pemphigoid in a psoriatic patient

Up to 20% of cases of bullous pemphigoid (BP) show an atypical presentation, exhibiting localized distribution or non-bullous lesions, such as eczematous, urticarial, prurigolike, and erythema multiformelike papules and plaques.1 These atypical presentations can be associated with a delay in diagnosis and thus require a high degree of suspicion. We present a case of recalcitrant BP localized to the anogenital region with subsequent generalization after administration of etanercept, a tumor necrosis factor–alpha (TNF-α) inhibitor.