Pemphigoid



Background

  • Commonest autoimmune sub-epidermal blistering disorder.
  • Auto-antibodies target “adhesion complexes” in the skin’s basement membrane = blister formation.
  • High relapse rate.

Clinical

  • Itchy +++, tense fluid filled blisters skin and/or mucous membranes.
  • Usually limbs, groin, and abdomen.
  • Older patients.
  • Beware septicaemia (especially if immunocompromised).

Differential Dx

  • Bullous pemphigoid.
  • Linear IgA disease.
  • Epidermolysis bullosa acquisita.
  • Bullous drug reaction.

Investigations

  • Clinical diagnosis.
  • Confirmatory biopsy ± immunofluorescence.
  • ↑CRP & ↑ESR.

Management

  • Potent topical steroids (clobetasol propionate).
  • Oral steroids or Dapsone (esp. for mucous membrane disease).
  • Tetracyclines ± nicotinamide in milder cases.
  • Immunosuppressants (MTX / Azathioprine) in severe cases.
  • Regular skin antiseptic soaks. and protective non-adherent dressings.
Bullous Pemphigoid - From BMJ 2013


Content By Dr Íomhar O' Sullivan 29/03/2013. Last review Dr ÍOS<4/12/18 -->.