Description

Bullous pemphigoid (BUL-us PEM-fih-goid) is a rare skin condition that causes large fluid-filled blisters. They often appear on the skin near the folds, such as the upper thighs and armpits. Sometimes, people get a rash instead of blisters. The affected areas can be painful, and are often very itchy. Blisters or sores that may also be of that form in the mouth, but this is rare.

Pemphigus occurs when the immune system attacks a layer of tissue in the skin. The reason of this immune system response is not well understood. In some people, the disease is caused by certain medications.

Pemphigus often goes away by itself in a few months, but can take up to five years to go away for good. Generally, the treatment helps to heal the blisters of the skin and prevent the formation of new ones.

The condition is more common in people over 60 years of age.

Symptoms

The symptoms of pemphigus may include:

  • Itching, which may begin weeks or months before blisters form.
  • Large blisters that do not break easily, often found along the folds of the skin. Brown-and-Black skin of the blisters of the skin may be pink, dark brown, brown or black. In white of skin that can be yellow, pink or red.
  • Pain.
  • A rash.
  • Small blisters or sores in the mouth or other mucous membranes. This is a symptom of a rare type of the disease of mucous membrane pemphigoid.

When to see a doctor

Consult a health care professional if you have:

  • Unexplained blisters.
  • The blisters on the eyes.
  • An infection.
  • The blisters that are opening and leakage.

Causes

The symptoms of pemphigus occurs when the immune system attacks a layer of tissue in the skin. The cause of this problem is that is not well understood. In some cases, the condition is caused by:

  • Drugs. There are several drugs that are known to increase the risk of pemphigus. Examples are water pills (diuretics such as furosemide (lasix); antibiotics such as amoxicillin, penicillin, and ciprofloxacin; Nsaids such as aspirin and ibuprofen; medications for diabetes such as sitagliptin (Januvia); and medicines to treat cancer, such as nivolumab and pembrolizumab.
  • The light and radiation treatments. Ultraviolet light therapy for the treatment of certain conditions of the skin can bring in pemphigus. In addition, the radiation to treat cancer can cause the disease.
  • Medical conditions. Psoriasis, lichen planus, dementia, Parkinson's disease, stroke, and multiple sclerosis are some of the conditions that may be associated with pemphigus.

The condition is not an infection and is not contagious.

Risk factors

Bullous pemphigoid is most common in people over 60 years of age, and the risk increases with age. The condition can be deadly for older people who have other conditions at the same time.

Complications

The possible complications of pemphigus include:

  • Infection.
  • Changes in the color of the skin after the affected skin healthy. This change in the color of the skin is called post-inflammatory hyperpigmentation as the skin darkens and post-inflammatory hypopigmentation when the skin loses color. People with brown or Black skin have a higher risk of long-term changes in the color of skin.
  • Side effects of the medicine that is used for the treatment of pemphigus.

Diagnosis

Your health care professional will talk with you about your symptoms and medical history and perform a physical examination. You may need tests to confirm a diagnosis of pemphigus. These may include blood tests, a biopsy of the skin or both. A biopsy is a procedure to remove a sample of tissue for testing in a lab.

Your healthcare provider may refer you to a specialist in diseases of the skin. This type of doctor is called a dermatologist.

Treatment

The treatment of pemphigus is aimed at healing the skin, relieving itching and pain, and the prevention of new blisters. Your health care professional will prescribe one or a combination of drugs:

  • Corticosteroids.The main treatment for pemphigus is a corticosteroid medication that is applied to the affected area. Usually a strong steroid cream, such as clobetasol propionate is used. The long-term use of this kind of drug comes with the risk of skin thinning and bruising. Your healthcare provider may also suggest a steroid medicine that is taken by mouth. Oral steroids come with the risk of harmful side effects, such as weak bones, diabetes, stomach ulcers, and eye problems.
  • Antibiotics. The oral medication, dapsone, and doxycycline help control the blisters.
  • The drugs that target the immune system. Some medicines may stop the immune system attacks the healthy tissues. Examples include azathioprine (Azasan, Imuran), rituximab (Rituxan), mycophenolate (CellCept), and methotrexate (Trexall). These drugs also carry a risk of harmful side effects, including infection. The people who take these medications require close follow-up and, sometimes, repeat blood tests to check for side effects.

Corticosteroids. The main treatment for pemphigus is a corticosteroid medication that is applied to the affected area. Usually a strong steroid cream, such as clobetasol propionate is used. The long-term use of this kind of drug comes with the risk of skin thinning and bruising. Your healthcare provider may also suggest a steroid medicine that is taken by mouth. Oral steroids come with the risk of harmful side effects, such as weak bones, diabetes, stomach ulcers, and eye problems.

Depending on how you respond to the first of the medications you try, your health care professional may suggest something other than steroids.

Bullous pemphigoid is usually disappear in time. The wounds can take weeks to heal, and it is common that the new form.

Lifestyle and home remedies

If you have pemphigus, you can help take care of your condition with the following self-care strategies:

  • Tips for the care of the wound. Follow your professional health care tips blisters.
  • The limitation of the activities if necessary. Blisters on the feet and hands can make it difficult to walk or go about daily tasks. The itching can make it difficult to sleep. You may need to change your routine, until the blisters are under control.
  • The protection of your skin. Try not to scratch the affected area. And protect the skin from excess heat and sun, even on cool, cloudy or foggy days.
  • Wearing loose cotton clothing. This helps to protect your skin.
  • Watching what you eat. Do not eat hard and crunchy foods if you have blisters in the mouth.

Coping and support

Pemphigus can be difficult to live with, especially if it affects your daily activities or causes of loss of sleep or stress. You may find it helpful to talk with other people who have or have had pemphigus. It is possible that you want to connect with a support group in person or online. Ask your health care professional for suggestions.

Preparing for your appointment

It is likely that you first consult your regular healthcare provider. Then, you may be referred to a health professional who specializes in disorders of the skin. This type of doctor is called a dermatologist.

Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

  • The symptoms that you've had and for how long.
  • The name and contact information of any health care professional that you have seen recently.
  • All the drugs, vitamins, and supplements you are taking, including dosage.
  • Questions to ask your health care professional.

For pemphigus, some basic questions to ask your health care professional include:

  • What is the most likely cause of my symptoms?
  • Do I need any tests?
  • How long will it take for the blisters to heal? They are going to leave scars?
  • Are the blisters can come back again?
  • What can I do to relieve the pain?
  • How much time do these changes in the skin for the last time?
  • What treatments are available, and which do you recommend?
  • What side effects can I expect from treatment?
  • I have other health conditions. How can I best manage them together?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Do you have any brochures or other printed material that I can take with me? What sites do you recommend?

What to expect from your doctor

Your healthcare provider will likely ask you a series of questions, such as:

  • When did these symptoms start?
  • Where are the blisters are located? What bothers them, exudate, drainage of pus, or bleeding?
  • Have you started a new medication?
  • Have you had a fever?
  • Nothing seems to improve the symptoms?
  • What measures have been adopted for the treatment of this condition yourself?
  • Have any of these measures helped?
  • Have you ever been treated by a health care practitioner for this condition?
  • If so, does the use of any other prescription treatments for this skin condition? If so, do you remember the name of the medication and dosage prescribed to you?
  • Do you have a skin biopsy?
Symptoms and treatment of Bullous pemphigoid