Bullous pemphigoid

Overview

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 creases, such as the upper thighs and armpits. Sometimes, people get a rash instead of blisters. The affected areas may be painful and are usually very itchy. Blisters or sores also might form in the mouth, but this is rare.

Bullous pemphigoid occurs when the immune system attacks a layer of tissue in the skin. The reason for this immune system response is not well understood. In some people, the condition is brought on by certain medicines.

Bullous pemphigoid often goes away on its own in a few months, but it may take as many as five years to go away for good. Treatment usually helps heal the blisters and prevent new ones from forming.

The condition is most common in people over age 60.

Symptoms

The symptoms of bullous pemphigoid may include:

• Itching, which can start weeks or months before blisters form.
• Large blisters that don't break easily, often found along skin folds. On brown and Black skin the blisters may be dark pink, brown or black. On white skin they may 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 called mucous membrane pemphigoid.

When to see a doctor

See a healthcare professional if you have:

• Unexplained blisters.
• Blisters on your eyes.
• An infection.
• Blisters that are opening up and leaking.

Causes

The symptoms of bullous pemphigoid occur when the immune system attacks a layer of tissue in the skin. The cause of this problem is not well understood. In some cases, the condition is brought on by:

• Medicines. Several medicines are known to increase the risk of bullous pemphigoid. Examples are diuretics such as furosemide; antibiotics such as amoxicillin, penicillin and ciprofloxacin; NSAIDs such as aspirin and ibuprofen; diabetic medicines such as sitagliptin (Januvia); and medicines to treat cancer such as nivolumab and pembrolizumab.
• Light and radiation treatments. Ultraviolet light therapy to treat certain skin conditions may bring on bullous pemphigoid. Also, radiation to treat cancer can cause the condition.
• Medical conditions. Psoriasis, lichen planus, dementia, Parkinson's disease, stroke and multiple sclerosis are among the conditions that may be related with bullous pemphigoid.

The condition isn't an infection and it isn't contagious.

Risk factors

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

Complications

Possible complications of bullous pemphigoid include:

• Infection.
• Changes in skin color after the affected skin heals. This change in skin color is called post-inflammatory hyperpigmentation when 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 skin color changes.
• Side effects from the medicine used to treat bullous pemphigoid.