What is bullous pemphigoid?
Bullous pemphigoid is a rare skin condition that usually affects middle-aged and older. The itching can lead to infections ranging from hives to large fluid-filled blisters. It affects a small area of the body or is widespread. The blisters usually appear on the skin, under the armpits or on the abdomen. One-third of people with bullous pemphigoid develop blisters in the mouth, throat, and oesophagus, as well as on the skin. It occurs when your immune system attacks a thin layer of tissue under the outer layer of your skin.
The cause of this abnormal immune response is unknown, although it can sometimes be triggered by taking certain medications. Bullous pemphigoid often goes away on its own within a few months, but it can take up to five years to resolve. Treatment usually helps the blisters heal and reduce itching. These include corticosteroid medications, prednisone, and other medications that suppress the immune system. Bullous pemphigoid can be fatal, especially in the elderly who are already in poor health.
Types of pemphigoid
All types of pemphigoid are caused by the immune system attacking healthy tissue. They appear as rashes and fluid-filled blisters. The types of pemphigoid vary depending on where and when the blisters occur on the body.
In bullous pemphigoid, the most common of the three types, blisters often appear on the skin of the hands and feet that cause movement. This includes the areas around the joints and abdomen.
Scar pemphigoid, also known as mucous pemphigoid, refers to blisters that form on the mucous membrane. These include:
The most commonly affected sites are the mouth and eyes. The rash and blisters start in one of these areas and spread to others if left untreated. If left untreated in the eyes, it can cause scarring, which can lead to blindness.
When blisters occur during or shortly after pregnancy, it is called pemphigoid pregnancy. Although it is not related to the herpes virus, it was previously known as herpes zoster.
Blisters usually develop in the second or third trimester but can occur during pregnancy or up to six weeks after delivery. Blisters form on the arms, legs, and abdomen.
What are the symptoms of bullous pemphigoid?
The itch of bullous pemphigoid is characterized by multiple blisters called urticaria, like beetles and bullets. These are commonly seen:
The blisters can break open and become a sore or open sore. The fluid inside may be clear or contain some blood. The skin around the blisters appears normal or red. The blisters are usually along the folds of the skin. If you think you may have bullous pemphigoid, you should seek medical help from your healthcare provider.
Causes of bullous pemphigoid
Blisters are caused by a malfunction of your immune system. Your body’s immune system generally produces antibodies to fight bacteria, viruses, or other harmful foreign substances. For obviously unknown reasons, the body develops an antibody against a specific tissue in your body. In bullous pemphigoid, the immune system produces antibodies against the fibres that connect the outer layer of the skin (epidermis) and the next layer of skin (skin). These antibodies induce inflammation that produces itching of bullous and bullous pemphigoid.
Bullous pemphigoid usually occurs randomly with no obvious factors for the onset of the disease. In some cases, these can be triggered by:
- Drugs Prescription medications that cause bullous pemphigoid include etanercept (Enbrel), sulfasalazine (Azulfidine), furosemide (Lasix), and penicillin.
- Light and radiation. Ultraviolet light therapy to treat certain skin conditions can trigger bullous pemphigoid, while radiation therapy can be used to treat cancer.
- Medical conditions Disorders that trigger bullous pemphigoid include psoriasis, lichen planus, diabetes, rheumatoid arthritis, ulcerative colitis, and multiple sclerosis.
Diagnosis of bullous pemphigoid
Your dermatologist will be able to diagnose your blisters very accurately by examining them. More evidence is needed to prescribe the appropriate treatment.
Your doctor may order a skin biopsy, which involves removing small samples of skin from the affected area. These samples are analyzed by laboratory technicians for antibodies characteristic of pemphigoid. These antibodies can also be found in your blood, so you must have a small blood sample.
Your doctor will usually start a test to find out if you have this disease by asking questions:
- When are your features tight?
- Do your blisters have pus or blood?
- Do you have a fever?
- Have you started any new medications?
Your doctor can run tests to confirm the diagnosis. These include blood tests and skin biopsy.
Bullous pemphigoid treatment
Treatment focuses on healing the skin and relieving itching, while at the same time reducing the negative side effects of the medications. Your doctor may prescribe one or a combination of medications:
- Corticosteroids The most common treatment is prednisone, which comes in pill form. But long-term use increases the risk of weak bones, diabetes, high blood pressure, high cholesterol, and infections. Corticosteroid ointment can be rubbed on the affected skin and cause fewer side effects.
- Steroid replacement medications. These drugs affect the immune system by blocking the production of white blood cells that fight your disease. Some examples are azathioprine (Azason, Imuran) and mycophenolate mofetil (Cellcept). If your signs and symptoms include eyes or upper GI tract, Ritu rituximab (Rituxan) may be used if other procedures do not help.
- Other anti-inflammatory drugs. Methotrexate (Trexol) is one example.
Lifestyle and home remedies
If you have this disease, you can take care of your condition with the following self-defence strategies.
- Wound care. Follow your doctor’s advice for the daily care of blisters.
- Limit activities if necessary. Blisters on the legs and arms make it difficult to walk or learn about daily activities. You will need to change your routine until the blisters are under control.
- Keep out of sunlight. Avoid prolonged sun exposure to any area of the skin affected by bullous pemphigoid.
- Wear loose cotton clothing. Help protect your skin.
- Watch what you eat. If you have blisters in your mouth, avoid eating hard, crunchy foods like potato chips and raw fruits and vegetables, as these types of foods can aggravate symptoms.