Bullous Pemphigoid Explained: Symptoms and Treatment

Medically Reviewed By Kevin Martinez, M.D.
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Bullous pemphigoid is an autoimmune disease that causes a blistering rash in older adults. Painful, fluid-filled blisters may appear on your lower stomach, groin, or other skin folds.

This article will explain what bullous pemphigoid is. It will also explain the condition’s symptoms, causes, and treatment options.

What is bullous pemphigoid? 

woman looking at her arm
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Bullous pemphigoid is an autoimmune disease that causes a painful skin rash. Large, fluid-filled blisters appear in the folds of your skin, lower abdomen, or groin.

What is an autoimmune disease? 

An autoimmune disease is a type of condition wherein your immune system does not function as expected. Some autoimmune diseases can run in your family. 

Your immune system’s role is to keep you from developing diseases or infections. This bodily system is responsible for preventing germs from attacking and multiplying in your body. Without a sufficient immune response, these germs will multiply to the point of causing an infection or disease.

Sometimes, your immune system becomes confused. When you have an autoimmune disease, your immune system cannot recognize its own tissue. It confuses healthy cells for invading germs instead. Your immune system will send its cells to attack your healthy cells as if protecting your body from infection.

Autoimmune diseases can cause different effects on your body, depending on which cells your immune system attacks. Bullous pemphigoid is the specific protein your immune system uses to attack your collagen and skin tissue. This changes the structure of your skin, causing a blistering rash to form. 

Bullous pemphigoid vs. pemphigus vulgaris

Bullous pemphigoid and pemphigus vulgaris are similar autoimmune diseases with painful blisters. However, pemphigus vulgaris happens primarily on the mouth and scalp.

The Nikolsky sign is one way to differentiate bullous pemphigoid and pemphigus vulgaris. 

Read more about autoimmune diseases here.

Who gets it? 

Anyone can get bullous pemphigoid. However, it is most common in adults aged 70 years or older. Globally, are about 2.4–23 instances of bullous pemphigoid for every 1 million people across all age groups. However, there are roughly 190–312 cases for every 1 million people aged 80 years and older. 

What are the symptoms of bullous pemphigoid? 

Image of bullous pemphigoid
Image of bullous pemphigoid

You may experience several skin symptoms due to bullous pemphigoid. These include:

  • blistering lesions filled with pus or blood
  • red, swollen skin before or after the blistering
  • hives

This skin condition usually begins with a small, raised rash that turns into larger blisters. The painful, itchy blisters or lesions may disappear and return again. 

Other defining characteristics of bullous pemphigoid include:

  • raised bumps in a range of sizes
  • large, fluid-filled sacs
  • a clear border around the blisters or hives

These painful lesions usually appear near areas that move, such as your armpits or knees. They can also congregate around your lower stomach and the groin area. Bullous pemphigoid rarely causes scarring. 

When should you contact a doctor?

Seek advice from your doctor if you notice a raised, red rash that itches. A dermatologist should look at the rash if it worsens or does not go away in a few days. With early treatment, they may be able to help stop the itchy areas from progressing into raised lesions.

If a large blister appears in a troublesome location, such as your hand or foot, do not pop the blister. You may introduce infection to the area after you break the skin. Your doctor can safely drain the area to minimize your risk of infection, if necessary.

How can you treat bullous pemphigoid?

There are several different treatment methods your doctor may recommend. You should follow the directions they provide regarding your treatment plan.

This autoimmune condition does not require lifelong treatment. Therefore, your doctor will likely discontinue your medication when the rash has resolved. Your doctor may recommend:

  • Steroid pills or cream: Steroids reduce inflammation and limit the time you have the rash. Your doctor may prescribe steroids at the lowest dose for the shortest time to minimize complications.
  • Antibiotics: Your doctor may recommend antibiotics to treat an infection if you have developed one.
  • Immunosuppressant medication: Your doctor may recommend immunosuppressant agents to help limit responses from your overly-active immune system.

Immunosuppressant medication may leave you vulnerable to other infections. 

Does it go away on its own? 

For most people, bullous pemphigoid may eventually go away on its own. It can take months to a few years to completely resolve. Treatment helps reduce the length of time that you will experience this skin condition.

Home remedies

You can use home remedies alongside medical treatment to alleviate some of your symptoms. 

Home remedies can include:

  • preventing excess sun exposure to the area
  • wearing loose-fitting, UV-protective clothing
  • refraining from activities that irritate the rash
  • limiting the amount of walking if blisters are on the feet
  • limiting activities, such as chores, if blisters are on the hands

You should refrain from scratching the rash because you may break the skin and introduce infection to the area. You can apply a cloth soaked in cold water to the skin for 20-minute intervals to help reduce itchiness. 

What causes bullous pemphigoid? 

Bullous pemphigoid is an autoimmune disease. An autoantibody causes the separation of layers in the skin, forming a blister.

Triggers and contributing factors

Trauma to your skin may cause bullous pemphigoid. Burns from the sun, heat, or radiation can all trigger this type of rash. Physically damaging your skin could also trigger the condition. Some medications, such as furosemide and penicillin, may play a role.  

How is bullous pemphigoid diagnosed?

To diagnose the condition, your doctor may ask about your symptoms and when your rash appeared. Then, they may assess the qualities of the rash to see if it may be bullous pemphigoid. 

If your doctor suspects bullous pemphigoid, they may recommend a biopsy. During a biopsy, a member of your healthcare team will remove a small tissue sample and send it to a laboratory. The laboratory can assess the sample to determine if you are experiencing bullous pemphigoid.

Summary

Bullous pemphigoid is a rare autoimmune disorder that causes blistering welts on the skin. These welts can be fluid-filled and itchy.

The condition usually occurs in people aged 70 years or older. Doctors typically conduct a biopsy to diagnose it. Treatment can include steroid cream or pills, antibiotics, and immunosuppressant medications. At-home remedies primarily seek to limit activities that affect the area.

Seek advice from your doctor if you develop any painful rashes or blistering on the skin.

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Medical Reviewer: Kevin Martinez, M.D.
Last Review Date: 2022 Jul 26
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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