What is Bullous pemphigoid?

Bullous pemphigoid can be defined as a skin condition that features blisters. In some cases the condition turns severe and serious. However, there are many skin conditions cause blisters and it is essential to know exactly what kind of disease one has got. Conditions similar to or sounding like those names also cause blisters. For instance, Pemphigus vulgaris and other kind of pemphigus can do that.

Such kind of different 'blistering' conditions vary vastly in their seriousness, appearance and to the treatments. There has been always a separate description about pemphigus vulgaris (that seems to be more serious disease as compared to Bullous pemphigoid).

Who gets bullous pemphigoid?

Bullous pemphigoid (BP) is quite uncommon - about 7 people in one million develop it each year in the US . Most affected people are aging above 60. It is very rarefied in children though; men and women are equally affected. The condition is not infectious and so; one cannot 'catch' it from infected person.

What causes Bullous pemphigoid?

This is an auto-immune disease. The immune system generally makes antibodies to attack microorganisms such as bacteria, viruses, and other germs. In people suffering from autoimmune diseases, the immune system will make antibodies against body’s own cells.

In people with Bullous, antibodies are produced against the membranes between the top layer of skin (called as epidermis) and the next layer (called dermis). Chemical reaction and inflammation in the skin is because of such antibodies’ attack that has caused fluid to retain as blisters between those two skinny layers.

It is not yet understood that why Bullous or other autoimmune disease occurs. It is thought that anything that triggers the immune system attacks the body's own cells. Possible triggers involve viruses, infections, sunrays, or other components. Certain medicines are also thought to be the triggering in a small number of people. For instance, Bullous is a rare side-effect of the medications like captopril, penicillins sulphasalazine, and furosemide. However, no exact component is identified in most cases till date.

People with this condition have a slightly higher than average chance to develop other autoimmune ailments like pernicious anemia, rheumatoid arthritis, and vitiligo.

Symptoms of Bullous pemphigoid

There would be small patches with itching at first. Blister develops a week or later. The blister is quite firm and dome in shape. They can range from less than 1cm-7cm across. The blisters’ fluid is generally clear, but might be blood-stained. Any areas of the skin can be affected but the arm, leg, armpit, and groin regions are the most common sites. The body might get covered with blisters but sometimes the blisters appear just at one site - often on the lower legs and inside mouth is rare case.

The skin of the blisters is quite hard and might remain for several days before the blisters burst. A raw patch of skin remains when blisters burst which then heal. Some blisters may burst but the fluid gets absorbed into the body and the roof of the blister gets back on the skin.

How does the condition progress?

The condition commonly lasts 1-5 years and then oftentimes eases or disappears. Future returns are quite possible, but they tend to be milder. If untreated, the blister and raw area of skin causes much discomfort. There could be a risk of getting serious infection occurrence on raw areas of skin.

Diagnosis and treatment

The diagnosis might not be clear at first sight. There are plenty of causes of mouth erosions and skin blisters. Hence, if a doctor suspects that one might have bullous, he or she refers you to a dermatologist, the skin specialist. Tests are usually carried out to confirm the diagnosis. They include:

The biopsy (a small sample) of skin is to be taken and sent for histopathology in the special laboratory. This could be looked under the microscope and tested to confirm that the blisters are because of bullous.

A blood test help detecting the antibody that might have caused bullous (the bullous auto-antibody).

Regarding treatment, there are many ways mentioned below –

Steroids: This is general remedy; steroids such as prednisolone are commonly prescribed. Steroids reduce the swelling and suppress the immune system. Higher doses might be needed at first. The dose is then reduced once blisters have stopped coming out. The lower daily doses are generally then required for preventing blisters forming. The target is to find the lowest dose needed controlling symptoms. The dose needed differs from person to person. A steroidal cream is sometimes used instead of steroid pills if the blisters are restricted to a small area of skin.

One might need steroid tablets until the condition totally disappears (generally for 1-5 years). In some cases, the doses of steroid need to control the disease are quite higher and may cause side-effects. Side-effects from steroids might be serious, especially if one takes higher doses of steroids for a longer period. For instance, one is more prone to certain infections if he or she takes regular higher doses of steroids.

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