Bullous Pemphigoid

Original article by Nick Lower | Last updated on 28/6/2014
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Aetiology

  • Elderly (>65yrs)
  • Vaccinations (in children with  condition affecting face, palms and soles) 
  • NSAIDs, furosemide, antibiotics
  • UV radiation / x-rays
 

Pathophysiology

  • Autoimmune, subepidermal blistering due to IgG  autoantibodies for the basement membrane proteins BP1 and BP2
  • IgG bind to basement membrane and activate inflammatory cascade.
 

Signs & Symptoms

  • Present acutely or insidiously
  • Often a pruritic prodromal rash & region
  • Thick, tense blisters  & erosions appear typically in flexural regions of limb and trunk 
  • Self limiting @ 2 yrs
  • Usually heal without scarring (unless cicatricial pemphigoid involving the mucous membrane)
 

Management

  • Topical if localised, systemic if severe. 
  • Corticosteroids (prednisolone)
  • Immunosuppressants (azathioprine/methotrexate)

 

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