Blisters Beyond Borders: Managing Chronic Bullous Disease of Childhood without Diagnostics

Abstract

Chronic bullous disease of childhood (CBDC) is a rare autoimmune blistering disorder typically diagnosed using direct immunofluorescence, which reveals linear IgA deposition along the basement membrane zone (1). However, in low-resource settings, such diagnostic tools are often unavailable, necessitating clinical diagnosis and empiric treatment. We describe a 3-year-old boy in rural Central Africa who presented with widespread tense bullae and erosions. Despite the lack of diagnostic testing, clinical features were highly consistent with CBDC. The patient showed significant improvement with corticosteroids and dapsone, highlighting the value of pattern recognition and pragmatic management in resource-limited environments.