Bullous pemphigoid
Definition
Bullous pemphigoid is an autoimmune disease that causes the appearance of bullae (fluid-filled blisters) on the skin.
Symptoms
The distinguishing feature of bullous pemphigoid is the appearance of tense bullae on healthy or reddish areas of skin. The lesions are generally symmetrical on both sides of the body and mainly affect the trunk, arms and legs. The face is rarely affected.
Itching may precede the appearance of blisters.
There are four main forms of the disease:
- The generalised bullous form
- The vesicular form characterised by very small blisters, located mostly on the hands
- The urticarial form which causes red patches and severe itching
- The prurigo-like form which causes diffuse itching; blisters are no longer present and are replaced by rounded crusts.
The disease and its symptoms progress by interchanging periods of flare-ups and remission.
Causes and risk factors
Bullous pemphigoid is an autoimmune disease, which means that the body's immune system attacks its own cells. This causes an inflammatory reaction.
The cause of this disorder is not yet precisely known, but could be linked to various environmental, hormonal, or genetic factors.
Diagnosis
Pemphigoid usually affects people aged over 60, but can also be found in children.
The following elements help establish the diagnosis:
- The age of the patient
- The absence of the mucous membranes’ involvement (mouth, nose, etc.)
- The presence of the bullae on the body
- The bullae are visible through a microscope (after a skin biopsy)
- Proof of the presence of antibodies in the skin
- Additional blood tests, confirming the presence of antibodies
Treatment
Setting up a regimen is strictly necessary. Treatments for bullous pemphigoid are very efficient and help cure the disease in most cases.
The main treatment consists of applying topical corticosteroids - creams or ointments. The treatment should be continued for several months (usually 4 to 6 months) so that no more bullae appear.
Sometimes immunosuppressive drugs can be used in case of a relapse. This also allows to limit the doses of corticosteroids.
To avoid secondary infection of the blisters, disinfection should be performed daily by a homecare nurse. Microorganisms (bacteria, viruses) can penetrate the blisters, causing a skin infection, and without regular treatment and disinfection, it can quickly worsen and spread.
Staying hydrated and having a balanced diet can also help: a sufficient protein intake allows better healing.
Living with the disease
Fortunately, when the blisters disappear, they leave no scars.
Due to the significant impact of bullous pemphigoid on the patient's quality of life, psychological care can be recommended, in order to better cope with the disease.
Published 24 Nov 2021
