Bullous Pemphigoid

Bullous pemphigoid is a rare disorder of the skin that causes large blisters. Blisters are thin sacs that contain clear fluid. This disorder is mostly seen in people over age 50. It can flare up for weeks or months. These flare-ups usually go away suddenly, and it may be months or years before another flare-up develops. The blisters appear most often in the groin, armpits, trunk, thighs, and forearms. These blisters can cause great difficulty with your daily activities because of severe itching and irritation. In most cases, this condition disappears completely within 6 years. However, a small number of people may still have flare-ups after completing treatment.

CAUSES

Bullous pemphigoid occurs when the body's own immune system attacks the layer of tissue beneath your skin. It is unknown why this attack occurs. In some cases, medicines can trigger blisters to form.

SYMPTOMS

The severity of flare-ups varies from person to person. In mild cases, there may be a few small blisters with slight redness or irritation. In severe cases, blisters are larger and there are many of them located in more areas of the body. Itching, redness, and irritation may be severe. The blisters may even break open to form sores (ulcers). Mouth sores and bleeding gums can develop. This makes eating difficult. A recurrent cough or pain with swallowing can also develop if the deeper part of the throat is affected. There may also be nosebleeds if the inner part of the nose is affected.

DIAGNOSIS

Your caregiver will do a physical exam. He or she may also take a tissue sample (biopsy) from the skin. This sample is examined in a lab to look for abnormal antibodies. Blood tests may also be done.

TREATMENT

Treatment is aimed at relieving your symptoms and preventing infection. Medicines prescribed by your caregiver may include:

  • Corticosteroids. These may be given as a pill or cream applied to the skin.

  • Antibiotics.

  • Vitamin B complex.

  • Medicines that suppress your immune system (immunosuppressive drugs).

Severe symptoms or complications from an infection may require hospitalization. This may be necessary for:

  • Management of wounds and ulcers.

  • Giving medicines through an intravenous line (IV).

  • Feeding if severe blisters or ulcers are affecting the mouth.

HOME CARE INSTRUCTIONS

  • Only take medicines as directed by your caregiver.

  • If your mouth or lips are affected, your diet should only include soft foods and liquids.

  • If your mouth or lips are affected, avoid drinking very hot liquids.

  • Do not break or drain your blisters.

  • Follow your caregiver's instructions for wearing bandages (dressings) over your blisters or ulcers.

SEEK MEDICAL CARE IF:

  • Your itching or pain is not helped by medicine.

  • You develop unexplained blisters on your skin.

  • You develop redness, swelling, or pain that extends beyond your blisters or ulcers.

  • You notice yellowish-white fluid (pus) coming from your wounds.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your pain becomes severe.

  • You cannot eat or drink because of blisters, ulcers, or pain in your lips or mouth.

  • You cannot care for yourself because of blisters, ulcers, or pain in your hands or the soles of your feet.

  • You have a fever.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.