Highlights & Basics
- Bullous pemphigoid typically occurs in older people and has a distinctive clinical appearance. There are several clinical variants, one of which occurs in childhood.
- In the prodromal, nonbullous phase, pruritus of variable intensity may be accompanied by eczematous or urticarial lesions for weeks or months.
- In the bullous stage, characteristic, tense vesicles or bullae develop on apparently normal or erythematous skin of the pre-existing eczematous or urticarial eruption. If the blisters burst, the eroded, crusty areas slowly heal to leave postinflammatory hyperpigmentation.
- The lesions are usually symmetric and favor the flexural aspects of the extremities, lower trunk, and abdomen.
- The treatment goal is to decrease or stop blister formation, to promote healing of existing blisters and erosions, and to control the associated pruritus. Topical and systemic corticosteroids, as well as other immunosuppressive and anti-inflammatory agents, are used.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Tense, fluid-filled blisters on normal and erythematous skin
Tense, fluid-filled blisters on normal and erythematous skin of the trunk and extremities
Vesicular variant: tense blisters
Light microscopy: subepidermal blister
Fibrin network is present in the blister cavity while the dermal infiltrate contains many eosinophils
Fibrin and eosinophils are present in the blister cavity
Linear band of IgG at the basement membrane zone
Citations
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Kirtschig G, Middleton P, Bennett C, et al. Interventions for bullous pemphigoid. Cochrane Database Syst Rev. 2010;(10):CD002292.[Abstract][Full Text]
Kirtschig G, Khumalo NP. Management of bullous pemphigoid: recommendations for immunomodulatory treatments. Am J Clin Dermatol. 2004;5:319-26.[Abstract]
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