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by Scholten A

Definition

Bullous pemphigoid is a disease that causes blisters to form on the skin. It often lasts for up to 5 years. Treatment can help.

Skin Blisters
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Causes

Bullous pemphigoid is an autoimmune disease. This means the immune system attacks its own tissue by mistake. Normally, the immune system attacks foreign matter to prevent or stop infections. In this disease, it attacks tissue just below the top layer of skin.

The exact cause of the disease is not clear. It may be linked to other immune problems.

Risk Factors

Bullous pemphigoid is more common in older people.

Other things that may raise the risk are:

  • Neurological diseases, such as:
  • Burns or trauma
  • UV radiation exposure
  • Radiation therapy
  • Certain medicines, such as penicillin or diuretics

Symptoms

The first symptom is often severe itching of the skin. A rash and blisters develop later. Blisters are usually clear. They are often found on the arms, legs, belly, and mouth, along skin folds. The blisters can break and form ulcers.

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. You may be referred to a skin specialist.

Tests may be done to rule out conditions with similar symptoms. Tests may include:

  • Blood tests
  • Skin biopsy —a sample of the affected tissue will be taken and tested

Treatment

Treatment depends on how severe the disease is. If medicines have played a role in the disease, they may be changed or stopped. Bullous pemphigoid responds well to treatment. It often disappears completely within 5 years.

Treatment options are:

  • Medicines to lower the immune system, such as:
    • Steroids (by mouth, injection, or applied to the skin)
    • Immunosuppressants (by mouth or injection)—for those who do not respond well to steroids
  • Antibiotics applied to the skin—prevent or to treat infections
  • Skin care, such as:
    • Leaving blisters alone, if possible—to prevent infection
    • Draining blisters that interfere with daily tasks
    • Bandaging and protecting raw areas

Prevention

There are no guidelines 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  https://www.canada.ca 

References

Bullous pemphigoid. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/diseases/15855-bullous-pemphigoid. . Accessed July 29, 2021.

Bullous pemphigoid. DermNet NZ website. Available at:https://www.dermnetnz.org/topics/bullous-pemphigoid/ . Accessed July 29, 2021.

Bullous pemphigoid. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/bullous-pemphigoid. Accessed July 29, 2021.

Bullous pemphigoid. NHS Choices website. Available at: https://www.nhs.uk/conditions/bullous-pemphigoid/. Accessed July 29, 2021.

Bullous pemphigoid. Primary Care Dermatology Society website. Available at: http://www.pcds.org.uk/clinical-guidance/bullous-pemphigoid1. Accessed July 29, 2021.

Sadik CD, Schmidt E. Resolution in bullous pemphigoid. Semin Immunopathol. 2019;41(6):645-654.

Revision Information

  • Reviewer: EBSCO Medical Review Board Dan Ostrovsky, MD
  • Review Date: 07/2021
  • Update Date: 07/29/2021