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Bullous pemphigoid is an autoimmune condition that causes blisters, mainly in older people. It can take years to resolve without treatment. Treatment involves corticosteroids or immunosuppressants, but long-term use can increase the risk of osteoporosis and infections. Sunscreen and dietary modifications can help.
Bullous pemphigoid is an autoimmune condition that typically affects older people, usually those age 60 or older. It causes outbreaks of blisters, which occur most often in the middle of the body or on the legs. There may be a number of blisters together which may eventually burst and scab, and then disappear. People can have recurrence of blisters in various parts of the body, and the disease can take many years to resolve without treatment.
As mentioned, bullous pemphigoid is an autoimmune condition. What appears to be happening is that the body turns on the top layers of skin and starts attacking them. This results in the formation of blisters. The disease can also spread to the mucous membranes and the body’s attack on itself can cause blisters to form in the mouth, which can be particularly annoying.
The basic symptoms of bullous pemphigoid are blisters, also called bullae. People can have a few blisters or they can have many, and the degree to which the blisters are prominent can vary. Some people may notice more of a rash, but not so much a rash made up of large blisters. Other symptoms people may have include itching, open sores, reddening of the skin, sore mouth and gums, sores in the mouth, and rashes that look like hives.
If people get a rash, they should see a doctor, as rashes could also indicate conditions like shingles. After taking an exam, doctors can usually test for bullous pemphigoid quite easily. They do this by removing a small amount of fluid from one or more blisters, which is then analyzed by a laboratory to look for the presence of antibodies, suggesting that the skin is fighting itself.
Once diagnosed, treatment tends to be very standard. Most people start by taking an oral corticosteroid and possibly using corticosteroid cream on the blistered areas. The problem is, it’s especially risky for women. Long-term use of corticosteroids is associated with more rapid development of osteoporosis. Osteoporosis is already a risk for postmenopausal women, who are more likely to get bullous pemphigoid. A good doctor can discuss options with women that can help minimize this risk. Sometimes other drugs called immunosuppressants are chosen instead if and when they seem more effective.
The other problem with treatment is that while the rash remains, it’s much more likely to create an infection. When the immune response is suppressed, as is the case with corticosteroids and immunosuppressants, infection is more likely. Those with this disease need to be vigilant if they notice the lesions become infected, feel warm to the touch, have red streaks radiating from the lesion, or appear pus-filled. People should be sure to report these symptoms or developing fever to doctors.
The good news about this disease is that treatment helps to improve, although this can still take time. Many people are symptom-free within a couple of years of starting a drug regimen. In severe cases it can take up to five years to recover from this disease. To avoid creating more skin irritation, people should be especially careful about using sunscreen if they have outdoor exposure. Those who have mouth sores could also be helped by slightly modifying their diet to avoid hard or sharp foods or highly acidic foods such as citrus fruits or vinegar.
