Difference between revisions of "Bullous pemphigoid"

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==Management==
 
==Management==
*Antihistamine for pruritis
+
*'''[[Antihistamine]]''' for pruritis
*Anti-inflammatory agents (eg, corticosteroids, tetracyclines, dapsone)
+
*'''Anti-inflammatory''' agents options
 +
**Oral Corticosteroids such as Prednisone 50mg PO daily
 +
**[[Tetracycline]] 1.5-2 g/day with Nicotinamide 1.5-2 g/day
 +
**Topical high potency steroids such as Clobetasol
 
*Immunosuppressants (eg, azathioprine, methotrexate, mycophenolate mofetil, cyclophosphamide).  
 
*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<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>
+
 
 +
''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 dx via biopsy
 
*Derm referral for dx via biopsy
  
 
==Sources==
 
==Sources==
*Medscape: http://emedicine.medscape.com/article/1062391-overview - last accessed Jan 2015
+
<references/>
*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==
 
==See Also==

Revision as of 15:08, 25 January 2015

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

  • Cicatricial Pemphigoid
  • Dermatitis Herpetiformis
  • Drug-Induced Bullous Disorders
  • Erythema Multiforme

Management

  • Antihistamine for pruritis
  • Anti-inflammatory agents options
    • Oral Corticosteroids such as Prednisone 50mg PO daily
    • Tetracycline 1.5-2 g/day with Nicotinamide 1.5-2 g/day
    • Topical high potency steroids such as Clobetasol
  • Immunosuppressants (eg, azathioprine, methotrexate, mycophenolate mofetil, cyclophosphamide).

Topical corticosteroids may offer similar treatment effect as oral steroids with less systemic effects.[2][3][4]

  • Derm referral for dx via biopsy

Sources

  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