Response to Letter to the editor of Borradori et. al. How to diagnose bullous pemphigoid and its variants: the question is still open.

With interest we read the recent letter by Borradori and colleagues,1 giving their opinion on how to diagnose bullous pemphigoid and its variants. The discussion about diagnosis of pemphigoid diseases has been continuous and is needful, since no evidence based diagnostic criteria are established yet and more than 20% of patients with bullous pemphigoid do not present with initial skin blistering.2-4 In the nonbullous pemphigoid variant clinical features are not as recognizable as in typical bullous pemphigoid and histopathology is often non-specific, opposing a real diagnostic challenge and potential diagnostic delay.5.