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Bullous Pemphigoid: A Clinical Summary

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.

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

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