Bullous pemphigoid is an autoimmune condition causing sub-epidermal blistering of the skin. This is secondary to the development of antibodies against hemidesmosomal proteins BP180 (more often) and BP230.

Epidemiology:

• Often presents in >80 year olds
• Can be associated with internal malignancies and neurological disorders

Bullous pemphigoid is more common in elderly patients. Features include

• itchy, tense blisters typically around flexures
  • itchiness can be prodromal - before blisters, itching is continuous
• the blisters usually heal without scarring
• there is usually no mucosal involvement (i.e. the mouth is spared)*

Skin biopsy

• immunofluorescence shows IgG and C3 at the dermoepidermal junction

Management

• referral to a dermatologist for biopsy and confirmation of diagnosis
• oral corticosteroids are the mainstay of treatment
• topical corticosteroids, immunosuppressants and antibiotics are also used