Bullous Eruption Following Methoxsalen Treatment in a Pediatric Patient with Vitiligo Vulgaris

A 10-year-old boy known case of vitiligo vulgaris with more than 30% of body surface area presented with multiple fluid-filled lesions over the depigmented patches after applying topical methoxsalen solution [Figure 1]. Four hours before the onset of the fluid-filled lesions, the patient applied undiluted 1% methoxsalen directly over the patches and was exposed to sunlight. A dermatological examination revealed multiple poly-sized sterile bullae over the preexisting vitiligo patches [Figures 2 and 3]. Lesions decreased in size after a week of taking prednisolone orally. The patient is currently on oral minipulse therapy in addition to narrowband ultraviolet B (NV-UVB) therapy, and he is responding positively to the treatment in the form of normal pigmentation of depigmented patches. Methoxsalen, a topical psoralen, is a photosensitizing agent used in the treatment of vitiligo vulgaris in combination with PUVA.[1] The uniqueness of this report is that topical methoxsalen-induced bullous eruption has been rarely reported in the literature.Figure 1: Multiple poly-sized sterile bullae over the pre-existing vitiligo patches with surrounding hyperpigmentation on the backFigure 2: Bulla over right areola and nipple region with leukotrichiaFigure 3: Multiple bullae over left ankle regionDeclaration of patient consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s)/guardian(s) of the patient. In the form, the parent(s)/guardian(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.