Difference between revisions of "Bullous pemphigoid"

(Management)
 
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*Blisters occur deep, within the epidermal basement membrane
 
*Blisters occur deep, within the epidermal basement membrane
 
*Bullae evolve over weeks to months
 
*Bullae evolve over weeks to months
*Risk factors
+
 
**Age > 60
+
===Risk factors===
**Female
+
*Age > 60
**Malignancy
+
*Female
**[[Furosemide]]
+
*Malignancy
 +
*[[Furosemide]]
  
 
==Clinical Features==
 
==Clinical Features==
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==Management==
 
==Management==
*'''Antihistamine''' for pruritus
+
*'''[[Antihistamine]]''' for pruritus
 
*'''Anti-inflammatory''' agents options
 
*'''Anti-inflammatory''' agents options
**Oral Corticosteroids such as Prednisone 50mg PO daily
+
**Oral [[corticosteroids]] such as [[prednisone]] 50mg PO daily
**[[Tetracycline]] 1.5-2 g/day with Nicotinamide 1.5-2 g/day  
+
**[[Tetracycline]] 1.5-2 g/day with nicotinamide 1.5-2 g/day  
 +
**[[Dapsone]] 50mg daily
 
**High potency [[topical steroids]] such as [[clobetasol]]  
 
**High potency [[topical steroids]] such as [[clobetasol]]  
 +
*''Topical corticosteroids may offer similar treatment effect as oral steroids with less systemic effects.''<ref>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].</ref><ref>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]. </ref><ref> 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].</ref>
 
*Immunosuppressants (eg, [[azathioprine]], [[methotrexate]], [[mycophenolate mofetil]], [[cyclophosphamide]]).  
 
*Immunosuppressants (eg, [[azathioprine]], [[methotrexate]], [[mycophenolate mofetil]], [[cyclophosphamide]]).  
*Most will require therapy for 6-60 months, mortality asso w disease usually secondary to medications
+
*Most will require therapy for 6-60 months, mortality associated with disease usually secondary to medications
 
 
''Topical corticosteroids may offer similar treatment effect as oral steroids with less systemic effects.''<ref>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].</ref><ref>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]. </ref><ref> 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].</ref>
 
 
*Derm referral for diagnosis via biopsy
 
*Derm referral for diagnosis via biopsy
  

Latest revision as of 20:19, 27 September 2019

Background

  • Chronic autoimmune blistering disease
  • Blisters occur deep, within the epidermal basement membrane
  • Bullae evolve over weeks to months

Risk factors

Clinical Features

Bullous pemphigoid.JPG
  • Bullae commonly occur in the axillae, abdomen, inner thighs, flexural forearms, and lower legs[1]
  • May be intensely pruritic
    • Start with urticarial lesions
    • Then tense blisters/bullae up to 10 cm
  • Nikolsky sign negative
  • Reported after UV/radiation therapy, drugs: furosemide, NSAIDs, captopril, antibiotics, vaccinations
  • Involves mucosa in 10-25%, may limit PO intake

Differential Diagnosis

Vesiculobullous rashes

Febrile

Afebrile

Management

References

  1. http://emedicine.medscape.com/article/1062391-overview
  2. 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].
  3. 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].
  4. 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].

See Also