Bullous Pemphigoid

• autoimmune condition causing large tense bullae (may be blood filled)

• more common than pemphigus

Pathology

• Separation of skin at dermo-epidermal junction

• Autoantibodies against "bullous pemphigoid antigens 1/2"

• Subepidermal split through basement membrane

• Immunofluorescence shows IgG along basement membrane

Clinical features

• Occurs in the elderly (80% >60)

• may be precede by intense itching and raised erythematous areas

• large, tense bullae anywhere on skin
• often limbs, hands, feet

• mucosal involvement rare

• erythematous or urticarial background
• may be haemorrhagic
• can be very itchy
• mucosal ulceration (cicatricial pemphigoid) uncommon but can causes scarring

Treatment

• high dose steroids (occasionally topical) + azathioprine
• for 2-3 years

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