Bullous pemphigoid

Revision as of 22:38, 24 January 2015 by Arsmd (talk | contribs) (edits)

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 (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].