Blisters (Bullous pemphigoid & pemphigus)

Question 1

What is bullous pemphigoid?

Answer 1

This is a chronic blistering skin condition with a relatively good prognosis. It is characterised by tense blisters, which are often flexural.

Epidemiology

• These have an average onset of over 65 years
• They have an equal distribution between men and women

Symptoms

• It is preceded by a pruritic erythematous rash
• Usually systemically well

Investigations

• Skin biopsy
• Immunofluorescence
• Pemphigoid antibodies

Treatment

• Topical super-potent steroid to de-roof blisters, e.g. topical clobetasol propionate
• Oral prednisolone
• Tetracyclines or methotrexate can be used for longer-term control

Question 2

What is bullous pemphigus?

Answer 2

A group of rare intra-epidermal autoimmune blistering diseases that can be life threatening. Widespread superficial blisters and painful erosions are caused by circulating autoantibodies that disrupt the desmosomal attachments between keratinocytes. There are two main variants: Pemphigus vulgaris and pemphigus foliaceus

Epidemiology
- Affects middle-aged (30-70)

Investigations

• Take a skin biopsy
• Histology and immunofluorescence
• FBC, U&Es, LFTs

Psychosocial Considerations
- Septicaemia is a major cause of death in these patients

Treatment

• Potent topical corticosteroids or oral treatment, e.g. prednisolone
• Oral ulceration and candida can be relieved with mouthwashes containing nyastatin and lidocaine