Bullous pemphigoid induced by Hijama therapy (cupping)

Bullous pemphigoid (BP) is described as a subepidermal blistering disorder, which is commonly reported among the elderly, particularly those older than 60 years of age. In this report, we present the case of a 41-year-old female patient with BP lesions that were initially detected at the site of Hijama therapy with a subsequent generalized spread. Punch biopsy from the lesions and perilesional direct immunofluorescence (DIF) demonstrated features of BP. The anti-BP180 level was 178 RU/mL, and the anti-BP230 level was negative. BP antigens at the site of Hijama caused an antibody response, which led to widespread blistering over the trunk due to epitope spreading. In a comprehensive review of the literature, a total of 22 BP patients with lesions due to physical trauma were studied, and clinical, immunological, and epidemiological information was gathered. This article is the first report on the occurrence of BP induced by Hijama therapy.