A 78-year-old male presents with a 3-month history of intensely pruritic, tense bullae on an erythematous and urticarial base, primarily affecting his trunk, flexural areas, and lower extremities. The lesions are difficult to rupture and a Nikolsky sign is absent. He denies any recent drug intake. Which of the following is the most likely diagnosis?

Explanation

The clinical presentation of an elderly patient with intensely pruritic, tense bullae on an erythematous/urticarial base, and a negative Nikolsky sign, is highly characteristic of Bullous Pemphigoid. Pemphigus Vulgaris typically presents with flaccid bullae, positive Nikolsky sign, and often involves mucous membranes. Dermatitis Herpetiformis presents with intensely pruritic papulovesicles, often grouped, on extensor surfaces, and is associated with celiac disease. Epidermolysis Bullosa Acquisita can present with tense bullae but is less common and often associated with trauma-induced blistering and scarring.