Blistering Disorders and Bullous Pemphigoid : Description, Management, Natural Treatment and Advice For Patient
-In general, blistering skin disorders can be divided into: immunobullous diseases (e.g. bullous pemphigoid, pemphigus vulgaris), blistering skin infections (e.g. herpes simplex) and other (e.g. porphyria cutanea tarda).
• The fragility of blisters depends on the level of split within the skin – an intraepidermal split (a split within the epidermis) causes blisters to rupture easily; whereas a sub-epidermal split (a split between the epidermis and dermis) causes blisters to be less fragile.
• The common causes of blisters are impetigo (see below), insect bites, herpes simplex infection , herpes zoster infection , acute contact dermatitis, pompholyx (vesicular eczema of the hands and feet, see below) and burns.
• Bullous pemphigoid and pemphigus vulgaris are uncommon conditions due to immune reaction within the skin.
Bullous Pemphigoid
Description
● A blistering skin disorder which usually affects the elderly
Cause
● Autoantibodies against antigens between the epidermis and dermis causing a sub-epidermal split in the skin
Presentation
● Tense, fluid-filled blisters on an erythematous base
● Lesions are often itchy
● May be preceded by a non-specific itchy rash
● Usually affects the trunk and limbs (mucosal involvement less common)
Management
● General measures – wound dressings where required, monitor for signs of infection
● Topical therapies for localised disease - topical steroids
● Oral therapies for widespread disease – oral steroids, combination of oral tetracycline and nicotinamide, immunosuppressive agents (e.g. azathioprine, mycophenolate mofetil, methotrexate, and other)
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