Bullous Pemphigoid
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Not to be confused with Bullous Pemphigus

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)
Bullous Pemphigoid
Bullous Pemphigoid. Pemphigus Vulgaris. Image from Dermnet. Used in accordance with Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand) license.

Management

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

 

References:
  • British Association of Dermatologists: Dermatology, a handbook for medical students & junior doctors
  • bad.org.uk
  • dermnetnz.org

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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