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Bullous Pemphigoid: Causes, Symptoms, Treatment, Epidemiology, Complications, Lifestyle Changes

What is Bullous Pemphigoid?

Bullous pemphigoid is a condition affecting the skin. This condition often affects the skin area that flexes. Examplesare the areas along the armpits lower abdomen and the upper thigh. People who are 60 years of age and above are normally affected by bullous pemphigoid.

Bullous Pemphigoid

When your immune system begins to attack the thin layer below the external layer of your skin, bullous pemphigoid will normally occur. It is not yet clear as to the reason why your own immune system responses abnormally like this. Certain medication can also trigger this condition.

Who are at Risk for Bullous Pemphigoid?

Bullous pemphigoid is rarely evident. 4 to 5 people in every 100,000 people contract this condition each year in the United Kingdom. Bullous pemphigoid is rarely found in children and most people found with the condition are older than 70 years. Bullous pemphigoid cannot be spread because it is non infections.

What is the Epidemiology of Bullous Pemphigoid?

Rare to see it in children, people who are over 70 are mostly affected by bullous pemphigoid. In each year approximately 14 out of 1 million people are affected. In Scottish men who are over 85 years, reported cases have reached a maximum of 472. Recent studies have indicated that cases of this condition might elevate in the UK. Reports also have indicated that women are less affected by half as compared to men. Other reports have stipulated that the condition does not vary basing on sexes.

What are the Causes of Bullous Pemphigoid?

It has not been understood clearly the cause of bullous pemphigoid. When the immune system has malfunctioned, the blisters will occur.

Antibiotics that fight foreign substances that are harmful, viruses and bacteria are always produced by the body. In some unclear circumstances an antibody might be developed by your body that attacks one organ tissue of the body.

Antibodies beneath the skin membrane are produced by the immune system when one has bullous pemphigoid. This position is a layer that is thin and situated between the second layer of the skin (dermis) and the layer outside (epidermis).

Factors that Contribute to Develop Bullous Pemphigoid

No clear factors have been proven to be contributing to contraction of bullous pemphigoid because its appearance is so random. A meager potion has been attributed to other medication.

  • Medication. Drugs that are prescribed are likely to cause bullous pemphigoid are furosemide (Lasix) sulfasalazine (Azulfidine) etanercept (Enbrel) and penicillin.
  • Radiation and light. Bullous Pemphigoid can be caused by radiation as a result of cancer therapy or certain UV lights for treating other skin ailments.

What are the Signs and Symptoms of Bullous Pemphigoid?

Blisters that does not rapture easily even when touched are primary features of bullous pemphigoid. Some blood may appear at fluid that is in the blisters. Red appearance may appear at the affected area and also it also appears normal.

The upper thighs, the groin, the arms and the lower abdomen is manly the part that the blisters will appear. Folds or places that creases on the skin for example the inner part of the joint will be affected mostly are Bullous Pemphigoid. The part of the skin that is affected will itch most of the time. Your mouth may develop sores or blisters too. In rare occasion can the eye’s mucous membrane be involved? Redness discomfort and soreness will always accompany this condition.

When can You Visit Your Doctor for Bullous Pemphigoid?

Development of blisters unexpectedly- this condition that is not because of poison ivy contact or allergy then you should see a doctor.

Your primary care doctor will be the first person you should see. You may then be referred to dermatologist (doctor specializing in disorders of the skin). Bringing a relative or a friend is advisable. This person can help with writing clinical information and other doctors recommendation in the process of the visit.

A List Must be Prepared:

You should be able to inform your doctor some information which includes:

  • The doctor’s name and his contact information either recent or regular.
  • The medication made and its dosage and prescription.
  • You’re regular OTCs (over the counter drugs) and any dietary supplement you might be taking regularly.

Your Expectation from Your Doctor:

A couple of questions are likely to be asked by your doctor. Thus prepare yourself to answer the following:

  • When was the day that the symptoms began?
  • The locations of the blisters are where? Are they itchy?
  • Have you bled or passed some pus or any oozing?
  • Have you undertaken any prescription recently?
  • Have you suffered from fever?

What are the Risk Factors for Bullous Pemphigoid?

Increase in age escalates the risk of contracting Bullous Pemphigoid. Normally, older adults who are above 60 are affected by this disease.

What are the Complications for Bullous Pemphigoid?

Sepsis can result due to the infected ruptured blisters in bullous pemphigoid. This infection affects the whole body and thus it is life-threatening. The immune system of older adults I relatively poor and this condition can bring serious complication. A condition known as scarring can also result if bullous pemphigoid affects the eye’s or the mouth’s mucous membrane.

What Tests are Conducted to Diagnose Bullous Pemphigoid?

A small part of your affected skin can be taken to the laboratory for further ascertainment by your physician.

How is Bullous Pemphigoid Treated?

In order to effectuate treatment, the immune system will be suppressed first. This will reduce blistering and itching. The target is achieving the right balance before starting treatment. The treatment must not come with any side effects since this process is only to reduce blisters which may be causing discomfort. It will be only up to the point which you can tolerate because of few symptoms and blisters. Absolute suppression of the immune system will mean that more side-effects may accrue and also the quantity of treatment will be massive.

Medicinal properties which are used for bullous pemphigoid treatment are:

Steroid Treatment for Bullous Pemphigoid

Effective and safe treatment for bullous pemphigoid is through the use of steroid creams also known as topical steroids. You will also have to be in possession of steroid creams for example (clobesasol). Most research has indicated that bullous pemphigoid even in severe cases will be effectively treated by using steroid creams. Creams are suggested to be more effective than tablets. Overall results are better with steroid creams and fewer side effects.

Bullous pemphigoid can be treated by steroid capsules like prednisolone. You can use the capsule when you have problems with the creams or there have been a widespread of rash. The immune system will be suppressed by the steroids and also it helps with the inflammation. The severity of the bullous pemphigoid will determine the dosage of steroid. Dosage can be reduced as blisters are clearing up but medium or high dosage can be administered at first. The dosage needed for complete control of symptoms using the lowest dose possible. This often varies from individual to individual.

Lower doses of tablets are recommended when one is using both creams and tablets. Six months up to four years is the time span for effective treatment. Bullous pemphigoid will disappear completely and does not usually recur.

Both cream and tablet steroids are accompanied by side-effects. Serious side-effects can always come up due to the use of steroid. This will be if one has taken high dose steroid for long. You will be vulnerable to other infections due to high dosage of steroid. A condition known as osteoporosis may result. This is the thinning of bones. In order to prevent osteoporosis from occurring, you will need to take calcium and vitamin D. This is mainly if you are taking steroids for longer than one month. Sudden stop from long term use of steroid treatment is not advisable.

Other Treatments for Bullous Pemphigoid

Bullous pemphigoid treatment can also be effectuated by some other form of treatment. These are:

  • If you have a raw skin, you will have to treat it by dressing it and caring for the wound.
  • If steroids have not worked, dapsone and sulfonamides are medicines which can be used.
  • Rituximab is a new form of treatment which has been of valuable use in instance that bullous pemphigoid has proven hard to cure.
  • Immunosuppressants for bullous pemphigoid:This is the inhibition of the white blood cells which are the body’s defense mechanism. Mycophenolate, azathioprine (Azasan, Imuran) and moffetil (cellcept). The prescription of the dose of prednisone that you may be requiring will be reduced by immunosuppressants.
  • Anti-inflammatories for bullous pemphigoid: Corticosteroids can be used along with drugs that have properties that are anti-inflammatory. Rheumatoid arthritis drug known as Methotrexate (trexall) a drug that is antibiotic and has anti-inflammatory properties and a drug to treat leprosy known as dapzone (aczone) are some of the examples.

What is the Long Term Outlook for Bullous Pemphigoid?

The outlook for bullous pemphigoid is relatively good following a comprehensive treatment. Most individual have a positive response to medication. After a few years of effective treatment the disease will disappear completely. Bullous pemphigoid can return any time even with effective and proper medication.

What are the Lifestyle Changes Required for Bullous Pemphigoid?

The following self-care guidelines will help you with taking care of bullous pemphigoid:

  • Avoid wounds. Your skin will be fragile due to the corticosteroid creams and bullous pemphigoid blisters. You will have to cover any ruptured blister with sterile clothing that is dry so as to avoid infection while healing.
  • Avoid exposing yourself to the sun. Any part affected by bullous pemphigoid should not be exposed to the sun for a long period of time.
  • Control your diet. Crunchy and hard food should be avoided if you have blisters in your mouth. Raw fruits, vegetables and chips are example of food that should be avoided. This is because symptoms are likely to be aggravated by using it.


  1. National Organization for Rare Disorders. (2021). Bullous Pemphigoid. https://rarediseases.org/rare-diseases/bullous-pemphigoid/
  2. DermNet NZ. (2019). Bullous Pemphigoid. https://dermnetnz.org/topics/bullous-pemphigoid/
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 25, 2023

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