Bullous pemphigoid

Bullous pemphigoid

Bullous pemphigoid is the appearance of itchy, fluid-filled blisters on the skin. These blisters more often appear in areas where the body folds, such as the armpits, groin, and lower abdomen.

Bullous pemphigoid can affect anyone, but it is more common in people 60 years of age and older. Symptoms of this disease generally appear in one area of ​​the skin, but can also spread to all parts of the body.

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Bullous pemphigoid needs to be treated immediately, to prevent new blisters and skin infections from forming.

Causes of Bullous Pemphigoid

Bullous pemphigoid is an autoimmune disease . In bullous pemphigoid sufferers, the body's immune system turns to attack the skin tissue that connects the outermost (epidermis) and middle (dermis) skin layers.

The above conditions cause inflammation which causes the epidermis and dermis to not bind together, causing blisters to appear.

It is not known exactly why the body's immune system attacks skin tissue, but this condition is thought to be triggered by the following factors:

  • Use of drugs, such as etanercept, sulfasalazine , and furosemide
  • Skin diseases, such as psoriasis and lichen planus
  • Certain medical disorders, such as diabetes, rheumatoid arthritis, ulcerative colitis , stroke, dementia, Parkinson's disease, and multiple sclerosis
  • Radiotherapy for the treatment of cancer and exposure to ultraviolet light

Bullous Pemphigoid Symptoms

The initial symptoms of bullous pemphigoid are changes in skin color to redness, blackness, and itching. These complaints generally appear in the folds of the skin, such as the armpits, groin, or stomach.

After a few weeks or months, blisters will appear on the surface of the skin filled with clear fluid or fluid mixed with blood. These blisters do not break easily when pressed gently. However, blisters that tear or burst can be painful but don't leave scars.

When to see a doctor

Immediately consult a doctor if you experience symptoms like the one above. You are also advised to undergo an examination if you experience the following complaints:

  • Signs of infection, such as fever and purulent skin
  • Blisters appear on the eyes, nose or inside the mouth

Diagnosis of bullous pemphigoid

To diagnose bullous pemphigoid, the doctor will conduct a question and answer about the symptoms experienced and the drugs the patient is taking, then proceed with a physical examination. To confirm the diagnosis, the doctor will carry out further examinations in the form of blood tests and skin biopsies .

Treatment of bullous pemphigoid

Treatment for bullous pemphigoid aims to get rid of skin blisters, relieve itching, and prevent new blisters from forming. Types of drugs that can be used for bullous pemphigoid include:


Corticosteroid class drugs aim to reduce inflammation by reducing the activity of the immune system. This drug is available in the form of ointment and tablets.

Corticosteroid tablets should not be used in the long term, because they can increase the risk of developing diabetes, hypertension, high cholesterol, brittle bones ( osteoporosis ), and infections. Therefore, treatment will be stopped gradually when the skin blisters have disappeared.

Medication is immunosuppressive

Similar to corticosteroids, these drugs work by suppressing the activity of the immune system. Immunosuppressive drugs are given so that the dose of corticosteroids can be reduced so that the side effects of corticosteroids can be avoided.

Some examples of immunosuppressive drugs are mycophenolate mofetil , methotrexate , rituximab , and azathioprine .

Antibiotic ointment

If signs of skin infection appear or the blisters break open, the doctor will prescribe an antibiotic ointment, such as tetracycline hydrochloride .

Bullous pemphigoid patients are also advised to take several steps to prevent the wound from getting worse, namely:

  • Avoid exposure to direct sunlight.
  • Wear cotton and loose clothing to reduce friction on the skin.
  • Bathe with special soap for sensitive skin and use a moisturizer after bathing.
  • Do not eat hard or crunchy foods if you have blisters in your mouth.
  • Limit activities that involve the body part with the blister.

Bullous pemphigoid complications

Bullous pemphigus that is not treated immediately and occurs in the long term can cause a number of the following complications:

  • Secondary infection
  • Sepsis
  • Formation of scar tissue
  • Old wounds heal

In addition, treatment of pemphigoid that is not appropriate to the patient's age, sex, and medical history can also cause complications, such as:

  • Diseases of the spinal cord
  • Osteoporosis and fractures
  • Squamous cell carcinoma
  • Lymphoma
  • Developmental disorders in children

Prevention of bullous pemphigoid

The cause of bullous pemphigoid is not known with certainty, so this disease cannot be prevented. However, there are efforts that people with this disease can take to prevent blisters from getting worse, including:

  • Avoid eating hard or crunchy foods, such as chips or crackers.
  • Avoid doing physical activities that cause injury to the skin.
  • Manage stress well.
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