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Bullous pemphigoid

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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This acquired autoimmune blistering disorder is characterized by large, tense, subepidermal blisters on an erythematous base.

Autoantibodies (mainly IgG) targeting the components of the basement membrane can be detected (1).

Usually it is a disease of the elderly (2), rarely presenting before 50 years of age. In the UK, it is more common than pemphigus with an annual incidence of 1 per 10000.

Both men and women are affected equally (1). Pemphigoid may be associated with malignancy although this is disputed in recent studies (1).

It is the most common cutaneous subepidermal bullous autoimmune disorder (2). There is a high mortality rate associated with this disease (3).

Pemphigoid may be associated with malignancy although this is disputed in recent studies.

Click here for an example image of bullous pemphigoid

Drug-associated bullous pemphigoid (4):

  • drugs associated with development of bullous pemphigoid include:
    • antibiotics
    • beta-blockers
    • non-steroidal anti-inflammatory drugs (NSAIDs)
    • diuretics
    • anti-tumor necrosis factor (TNF)-alpha
    • dipeptidyl peptidase 4 inhibitors (DPP-4i)
    • immune checkpoint inhibitors targeting programmed cell death receptor 1 (PD-1) and its ligand (PD-L1)

High potency topical steroids and systemic steroids are the current mainstay of therapy (5).


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