Bullous pemphigoid

Diagnosis

Your healthcare professional will talk with you about your symptoms and medical history and conduct a physical exam. You may need tests to confirm a diagnosis of bullous pemphigoid. These may include blood tests, a skin biopsy or both. A biopsy is a procedure to remove a sample of tissue for testing in a lab.

Your healthcare professional may refer you to a specialist in skin conditions. This type of doctor is called a dermatologist.

Treatment

Treatment of bullous pemphigoid is aimed at healing the skin, relieving itching and pain, and preventing new blisters. Your healthcare professional will likely prescribe one or a combination of medicines:

• Corticosteroids. The main treatment for bullous pemphigoid is corticosteroid medicine applied to the affected area. Usually a strong steroid cream such as clobetasol propionate is used. Long-term use this type of medicine comes with the risk of skin thinning and easy bruising. Your healthcare professional might also suggest a steroid medicine 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 medicines you try, your healthcare professional may suggest something other than steroids.

• Antibiotics. The oral medicines dapsone and doxycycline help control blisters.
• Medicines that target the immune system. Some medicines can stop your immune system from attacking healthy tissues. Examples are azathioprine (Azasan, Imuran), rituximab (Rituxan), mycophenolate (CellCept) and methotrexate (Trexall). These medicines also have a risk of harmful side effects, including infection. People who take these medicines need close follow-up and, at times, repeat blood tests to monitor for side effects.

Bullous pemphigoid is usually goes away in time. Sores can take weeks to heal, and it's common for new ones to form.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

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

• Following wound care advice. Follow your healthcare professional's advice for care of blisters.
• Limiting activities if needed. Blisters on the feet and hands can make it difficult to walk or to go about daily tasks. The itching may make it hard to sleep. You may need to change your routine until the blisters are under control.
• Protecting your skin. Try not to scratch the affected area. And protect your skin from too much heat and sun, even on cool, cloudy or hazy days.
• Wearing loose-fitting cotton clothes. This helps protect your skin.
• Watching what you eat. Don't eat hard and crunchy foods if you have blisters in your mouth.

Coping and support

Bullous pemphigoid may be difficult to live with, especially if it affects your daily activities or causes lost sleep or stress. You may find it helpful to talk with others who have or had bullous pemphigoid. You may want to connect with a support group in person or online. Ask your healthcare professional for suggestions.

Preparing for your appointment

You're likely to first see your regular healthcare professional. You may then be referred to a healthcare professional who specializes in skin disorders. This type of doctor is called a dermatologist.

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

What you can do

Before your appointment make a list of:

• Symptoms you've been having and for how long.
• The name and contact information of any healthcare professional you have seen recently.
• All medicines, vitamins and supplements you take, including doses.
• Questions to ask your healthcare professional.

For bullous pemphigoid, some basic questions to ask your healthcare professional include:

• What's the most likely cause of my symptoms?
• Do I need any tests?
• How long will it take for the blisters to heal? Will they leave scars?
• Will the blisters come back again?
• What can I do for the pain?
• How long will these skin changes last?
• 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 I can take with me? What websites do you recommend?

What to expect from your doctor

Your healthcare professional is likely ask you a number of questions, such as:

• When did these symptoms begin?
• Where are the blisters located? Do they itch, ooze, drain pus or bleed?
• Have you started any new medicines?
• Have you had a fever?
• Does anything seem to improve your symptoms?
• What steps have you taken to treat this condition yourself?
• Have any of these measures helped?
• Have you ever been treated by a healthcare professional for this condition?
• If so, did you use any prescription treatments for this skin condition? If so, do you remember the name of the medicine and the dosage you were prescribed?
• Did you have a skin biopsy?