Bullous pemphigoid is a skin disorder characterized by large blisters. Bullous pemphigoid usually occurs in elderly persons and is rare in young people. Symptoms come and go. In most patients, the condition goes away within 6 years. Bullous pemphigoid (BP) is rare - about seven people in a million develop it each year in the UK. Most affected people are aged over 60. It is very rare in children. Men and women are equally affected. Symptoms of bullous pemphigoid include hard, tight blisters on the skin. The skin around the blisters may appear normal, but is often red and swollen. Itching is common. In the early stages of this disease, the skin may be itchy without any other symptoms. About one-third of persons with bullous pemphigoid also develop blisters in the mouth.

The blisters may break open and form ulcers or open sores. Bullous pemphigoid is thought to occur because IgG immunoglobulins (antibodies) and activated T lymphocytes (white blood cells) attack components of the basement membrane. Treatment is usually needed for several years. Treatment is focused on relief of symptoms and prevention of infection. Tetracycline and Minocycline antibiotics are very useful for mild to moderate disease. Oral steroids (prednisone, prednisolone) are the treatment of choice for severe cases. Antibiotics called tetracyclines may be useful in mild cases. Niacin (a B complex vitamin) is sometimes given along with tetracycline. Immunosuppressive agents (Immuran, cyclophosphamide and Neoral) are used in combination with the oral steroids to allow a lower dose.

Corticosteroids help relieve inflammation. Some corticosteroids are taken by mouth, while others require a shot (injection). In persons with early forms of the disease, corticosteroid creams may be used. These types of drugs must be tapered off slowly under a doctor’s supervision. Do not stop taking a corticosteroid drug suddenly. Other treatments that have been used for severe disease include intravenous immunoglobulin infusions, typically given monthly. The dose of prednisone is then slowly reduced over many months or years. As systemic steroids have many undesirable side effects. With careful management, most patients with BP do well. Be patient and faithfully follow your instructions, these are the keys to good results.

Bullous Pemphigoid Treatment and Prevention Tips

1. Corticosteroids help relieve inflammation.

2. Niacin (a B complex vitamin) is sometimes given along with tetracycline.

3. Oral steroids (prednisone, prednisolone) are the treatment of choice for severe cases.

4. Tetracycline and Minocycline antibiotics are very useful for mild to moderate disease.

5. Immunosuppressant such as azothiaprine, ciclosporin, etc, may also be advised in addition to steroids.