Bullous pemphigoid

Bullous pemphigoid is an autoimmune reaction to an antigen in the basement membrane zone.
Clinically, it is characterized by tense blisters on an erythematous background.
It is more common in the elderly.

Fatalities, when they occur, are generally secondary to systemic infection from large areas of denuded skin. Bullous pemphigoid is less likely to be fatal than pemphigus vulgaris.

Treatment:

• Localized bullous pemphigoid may respond to strong topical corticosteroids or intra-lesional corticosteroids
• Tetracycline alone or in combination with nicotinamide is an option for those who need to avoid longterm immunosuppression
• Dapsone is worth considering if the pathology shows predominant neutrophils
• The immunosuppressant anti-cancer drugs may allow lower doses of corticosteroids to be used
• The newer drugs such as mycophenolate mofetil have been used as a steroid-sparing drug. This is less toxic than other traditional immunosuppressants.

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