200 Section - Stump pemphigoid - a case report

Stump pemphigoid is a rare variant of bullous pemphigoid with an etiology that remains poorly understood. Although this condition is infrequently reported, it is essential to recognize because of its major impact on the quality of life of individuals with limb loss. Its clinical resemblance to eczema or friction blisters often makes the diagnosis particularly challenging. Furthermore, it poses a significant challenge during rehabilitation by limiting prosthesis use.

Case Description:

We present the case of a 63-year-old man with a left vascular transtibial amputation who developed recurrent bullae on the distal and anterior aspects of his residual limb during rehabilitation. Lesion diameters ranged from a few millimetres to 3 centimeters and forced temporary suspension of prosthetic use at three separate occasions.

Discussions:

Potential causal factors included friction, trauma to the residual limb and hyperhidrosis, although blister formation also occurred spontaneously. A skin biopsy was performed and confirmed the diagnosis of stump pemphigoid. This dermatological condition caused significant self-reported psychological distress and functional limitations, which were corroborated by the rehabilitation team. These impairments ultimately led to restricted mobility and environmental accessibility. Effective management therefore required a multidisciplinary approach. Topical treatments (topicort and pimecrolimus) were unsuccessful, while optimal outcomes were achieved with combined mycophenolate mofetil and prednisone therapy, together with temporary interruption of prosthetic use.

Conclusions:

This case highlights the importance of recognizing stump pemphigoid as a potential cause of recurrent bullae in amputees. Early diagnosis and multidisciplinary management are essential to optimize functional recovery and prosthetic use.