Bullous pemphigoid
Background
- Chronic autoimmune blistering disease
- Typically older than 60 years of age
- Blisters occur deep, within the epidermal basement membrane,
- Bullae evolve over weeks to months
Clinical Presentation
- Bullae commonly occur in the axillae, abdomen, inner thighs, flexural forearms, and lower legs[1]
- May be intensely pruritic
- Nikolsky sign negative
- No mucous membrane involvemet
Differential Diagnosis
Other Rash
- Acute generalized exanthematous pustulosis
- Allergic reaction
- Aphthous stomatitis
- Atopic dermatitis
- Coxsackie
- Dermatitis herpetiformis
- Exfoliative erythroderma
- Impetigo
- Pellagra
- Pityriasis rosea
- Serum Sickness
- Tinea capitus
- Tinea corporis
- Vitiligo
Other Rash visual diagnosis
Psoriasis before and after treatment.
- Cicatricial Pemphigoid
- Dermatitis Herpetiformis
- Drug-Induced Bullous Disorders
- Erythema Multiforme
Management
- Antihistamine for pruritis
- Anti-inflammatory agents (eg, corticosteroids, tetracyclines, dapsone)
- Immunosuppressants (eg, azathioprine, methotrexate, mycophenolate mofetil, cyclophosphamide).
- European article: evidence that strong topical corticosteroid treatment may achieve disease control while avoiding systemic adverse effects from systemic corticosteroids[2][3][4]
- Derm referral for dx via biopsy
Sources
- Medscape: http://emedicine.medscape.com/article/1062391-overview - last accessed Jan 2015
- Joly P, Roujeau JC, Benichou J, et al. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med. Jan 31 2002;346(5):321-7. [Medline].
- Terra JB, Potze WJ, Jonkman MF. Whole body application of a potent topical corticosteroid for bullous pemphigoid. J Eur Acad Dermatol Venereol. Apr 3 2013;[Medline].
- Gual A, Iranzo P, Mascaró Jr JM. Treatment of bullous pemphigoid with low-dose oral cyclophosphamide: a case series of 20 patients. J Eur Acad Dermatol Venereol. Apr 13 2013;[Medline].
See Also
- ↑ http://emedicine.medscape.com/article/1062391-overview
- ↑ Joly P, Roujeau JC, Benichou J, et al. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med. Jan 31 2002;346(5):321-7. [Medline].
- ↑ Terra JB, Potze WJ, Jonkman MF. Whole body application of a potent topical corticosteroid for bullous pemphigoid. J Eur Acad Dermatol Venereol. Apr 3 2013;[Medline].
- ↑ 2. Gual A, Iranzo P, Mascaró Jr JM. Treatment of bullous pemphigoid with low-dose oral cyclophosphamide: a case series of 20 patients. J Eur Acad Dermatol Venereol. Apr 13 2013;[Medline].