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


  • 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


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


  • 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 ÍOS10/06/21.