Bullous pemphigoid (BP) is an autoimmune blistering disease. In a healthy person, the immune system protects the body from invaders. In BP, the immune system mistakenly attacks healthy skin tissue, leading to the formation of blisters.
Causes:
The exact cause of BP is unknown, but it's believed to be a combination of genetic predisposition and environmental triggers. Certain medications and underlying medical conditions may also play a role.
Clinical Features:
Itching: Intense itching, sometimes preceding the appearance of blisters, is a common symptom.
Blisters: Tense, fluid-filled blisters that arise on normal or reddened skin, typically on the flexural areas (groin, armpits, inner thighs) and mucous membranes (mouth).
Nikolsky's sign: A diagnostic test where gentle pressure on apparently healthy skin causes the top layer to separate, revealing a raw, underlying area.
Diagnosis:
Physical examination: A dermatologist will examine the skin and may perform Nikolsky's sign.
Biopsy: A small skin sample is taken and examined under a microscope to confirm the presence of subepidermal blisters, a hallmark of BP.
Direct immunofluorescence (DIF): A test that detects specific immune deposits in the skin, helping differentiate BP from other blistering diseases.
Treatment:
Corticosteroids: Topical or oral steroids are the mainstay of treatment to suppress the immune response.
Immunosuppressants: Medications like azathioprine or mycophenolate mofetil may be used alongside steroids to reduce the dosage and side effects.
Wound care: Proper wound care is crucial to prevent infection and promote healing of existing blisters.
Source: Dr Aloosh
