Last reviewed by Editorial Team on August 13th, 2018.
What is Bullous Pemphigoid?
This is a rare skin condition that will normally appear as large blisters on your skin that are filled with fluid. These blisters will usually appear on areas of your skin like your upper thighs, armpits, lower abdomen, etc that often flex. It is also considered a persistent skin condition. This rare skin condition can affect anyone but is mostly seen in older adults over the age of sixty. It is considered a chronic or acute autoimmune disease. It is known more appropriately as bullae. Each year there can be seven to fourteen cases per a million people but there have been numbers as high as four hundred seventy-two cases per a million people. Some studies show that it will affect men twice as often as females.
The basic symptom of having bullous pemphigoid is the fluid-filled blisters. There can just be a few blisters or there can be several. The degree in which the blisters are prominent may also vary. Some of the other symptoms a person might have with bullous pemphigoid can include:
- The blisters will not rupture easily when they are touched
- Normally the fluid in the blisters is clear but they can have some blood in them
- The skin that surrounds the blisters may look normal but in people with dark colored skin the surrounding skin can look darker and in people with lighter skin the surrounding skin can look reddish in color.
- If the blisters rupture they can be painful or sensitive.
- A person may also have hives which are raised areas that are red or dark in color and swollen which can happen before the blisters happen. Many cases having hives is often the only lesion of your skin that will happen
- A person may also have extremely itchy skin in the area(s) that are affected.
- Some people may develop blisters or sores in their mouth as well but seldom on other mucous membranes.
- Burning sensations
- The affected inner lining tissues can peel away
- Having sensitivity to foods that are acidic.
- It could be difficult to eat because of the involvement in the deeper areas of your throat. It can also cause coughing.
- Possible nosebleeds because of the involvement of your inner nose
Bullous Pemphigoid Causes
The main cause is when your immune system attacks a thin layer of tissue below the outer edge of your skin. The reason that your body might have this abnormal immune response is not known but some physicians think it can sometimes be triggered by certain medications you are taking. It is also thought that it is caused by taking antibiotics and inflammation that is accumulating in a particular layer of your mucous membranes or skin that is not normal. This layer of tissue is often called the basement membrane. This basement membrane is the thin layers of fibers that connect the outer layer of your skin and the next layer of skin. It is sometimes thought to be from an aging immune system because of the age group it appears to affect more often. When a person has bullous pemphigoid your immune system will develop antibodies to this basement membrane of your skin and then they start an inflammatory activity that can produce the blisters, itching, and hives, all characteristics of this rare skin condition. When a person has this skin condition it will usually appear erratically.
There can also be contributing factors such as:
- Medications – some of the prescription medications that can cause bullous pemphigoid can include penicillin, Azulfidine, Lasix, and Enbrel.
- Radiation and light – when ultraviolet light therapy that dermatologist may use to treat some skin condition it could trigger this rare skin condition. The radiation therapy that is used to treat cancer may also cause this rare skin condition.
The main goal of treatment is to help your skin heal as quickly as it can in order to relieve the itching bullous pemphigoid can cause. To inhibit your immune system activities that can cause inflammation your physician may prescribe a combination of medications. Some of these medications can include:
- Immunosuppressants – this medication will inhibit the production of your disease fighting white blood cells and can also help to reduce the dosage of prednisone you may need. Two of these medications are CellCept and Imuran.
- Corticosteroids – the most common corticosteroid used is prednisone which is a pill. Unfortunately using it for long-term can increase your risk of developing diabetes, high cholesterol, cataracts, weak bones, and high blood pressure. There is also corticosteroid ointment that can be rubbed on the affected areas of your skin and have fewer side effects.
- Anti-inflammatory – a variety of medication with anti-inflammatory properties can be used alone or in combination with other corticosteroid medications. Some of these medications can include Trexall, and Aczone.
After you start treatment you will notice that the symptoms are improving within several weeks but normally you will need to have continuing therapy for several years. There are often times if you do not treat bullous pemphigoid may resolve itself in several months to many years. If the blisters do break you should put some type of antibacterial ointment on them to prevent an infection. You could also cover them with a bandage to prevent anything from getting into the burst blister.
Is bullous pemphigoid contagious?
Because it is an autoimmune system skin condition it is not contagious.