The vesicular variant of bullous pemphigoid (BP) is a clinical entity in which the principal types of lesions are multiple small tense vesicles in a symmetric distribution, rather than large, more randomly distributed bullae. We present a patient who developed an intensely pruritic eruption which clinically was suggestive Of typical dermatitis herpetiformis (DH), but subsequently developed large bullae typical of BP. Histologic and immunofluorescence findings, as well as initial response to systemic corticosteroids, were typical of BP. In addition, our patient required the administration of methotrexate to maintain clearance of lesions while prednisone was being tapered, a problem which has not been mentioned in the other patients described in the literature with vesicular variants of BP.