• Bullous Pemphigoid

    Definition

    Bullous pemphigoid is an autoimmune disorder that causes blistering of the skin. It is a long-term condition that is most common in the elderly.
    Skin Blisters
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    Causes

    The immune system normally attacks foreign matter to prevent or stop infections. When the immune system attacks healthy tissue it is called an autoimmune disorder. In bullous pemphigoid, the immune system attacks tissue just below the top layer of skin.
    The exact cause of bullous pemphigoid or autoimmune disorders in general is not clear. Some bullous pemphigoid may be associated with other immune diseases such as diabetes or rheumatoid arthritis.

    Risk Factors

    Bullous pemphigoid is more common in people aged 60 years and older.
    In a small number of cases bullous pemphigoid may occur after:
    • Neurological diseases, such as epilepsy
    • Certain medication, such as penicillin
    • Burns or trauma
    • Ultraviolet (UV) radiation exposure
    • Radiation therapy

    Symptoms

    Severe itching of the skin is often the first sign. Eventually a rash and blistering will develop. Blisters are usually clear and are most commonly seen on the arms, legs, abdomen, and mouth, usually along creases in the skin. The blisters can break and form ulcers.
    It may be a few years between the start of itching and the appearance of a rash.

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a skin specialist.
    Tests may be done to help distinguish bullous pemphigoid from other conditions with similar symptoms. Tests may include:
    • Blood tests
    • Skin biopsy—a sample of the affected tissue will be removed for testing

    Treatment

    Bullous pemphigoid responds well to treatment and usually resolves completely within 5 years. Talk with your doctor about the best treatment plan for you. Options include:
    Medications
    Certain medications may help lower the immune system and decrease damage to the skin. Medication options may include:
    • Steroids—(topical, oral, or injected) to reduce the immune system reaction
    • Immunosuppressant medication—(oral or injected) to lower the immune system reaction in those that do not respond well to steroids
    • Antibiotics—(topical) to treat infection and reduce inflammation in those who cannot take steroids or have to take reduced doses of steroids; they may be used with steroid creams
    Antibiotics or antiseptic medications may also be used to prevent or treat infections in broken skin.
    Skin Care
    Blisters will be left intact when possible. However, blisters that interfere with daily tasks may be drained.
    Proper skin care will decrease the risk of infection in damaged skin.

    Prevention

    Since the cause is not clear, there is no known way to prevent bullous pemphigoid.

    RESOURCES

    American Academy of Dermatology https://www.aad.org

    American Osteopathic College of Dermatology http://www.aocd.org

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Bullous pemphigoid. American Osteopathic College of Dermatology website. Available at: http://www.aocd.org/?page=BullousPemphigoid. Accessed April 5, 2016.

    Bullous pemphigoid. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/diseases%5Fconditions/hic-bullous-pemphigoid. Updated July 13, 2015. Accessed April 5, 2016.

    Bullous pemphigoid. DermNet NZ website. Available at: http://www.dermnetnz.org/immune/pemphigoid.html. Updated January 2016. Accessed April 5, 2016.

    Bullous pemphigoid. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 15, 2015. Accessed April 5, 2016.

    Bullous pemphigoid. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/dermatologic-disorders/bullous-diseases/bullous-pemphigoid. Updated June 2013. Accessed April 5, 2016.

    Bullous pemphigoid. NHS Choices website. Available at: http://www.nhs.uk/conditions/bullous-pemphigoid/Pages/bullous-pemphigoid.aspx. Updated December 5, 2015. Accessed April 5, 2016.

    Bullous pemphigoid. Primary Care Dermatology Society website. Available at: http://www.pcds.org.uk/clinical-guidance/bullous-pemphigoid1. Accessed April 5, 2016.

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