Medicines for Bullous pemphigoid

What it is

Bullous pemphigoid is an autoimmune skin condition that causes large, tense, fluid-filled blisters on the skin. It happens when the immune system mistakenly attacks a layer that helps hold the skin together, causing the outer layer to lift and blister. It mainly affects older people. Often, before the blisters appear, there is a period of itchy, red or discoloured, raised patches (which can resemble hives or eczema), and then the characteristic blisters develop — these are typically large, firm ("tense"), and fluid-filled, appearing on areas such as the arms, legs, trunk and skin folds, and can be very itchy. Because the blisters are tense, they do not break as easily as in some other blistering conditions, but when they do, they leave raw areas that heal. The condition tends to come and go over time and is usually a chronic condition that is managed rather than cured, though in many people it eventually settles over months to years. It is not contagious. Because widespread blistering can affect wellbeing and the raw areas can become infected, and because treatment is effective, bullous pemphigoid is assessed and managed, usually with specialist input.

How it is treated

Bullous pemphigoid is diagnosed by a doctor, often a dermatologist, usually with a skin biopsy and blood tests to confirm it and distinguish it from other blistering conditions. Treatment aims to control the itching and blistering, heal the skin, and prevent new blisters, by calming the overactive immune response, and is tailored to the severity. For more localised or milder disease, strong topical steroid creams or ointments applied to the affected skin can be very effective and are often the first choice, as they act on the skin with fewer body-wide effects. For more widespread or severe disease, treatments taken by mouth are used — such as steroids and other medicines that reduce immune activity, and sometimes certain antibiotics that have a helpful effect in this condition — with the aim of controlling the disease using the lowest effective treatment over time. Good skin and wound care, and treating any infection of broken blisters, are important, along with managing itching. Because treatment (especially longer-term immune-suppressing medicines) needs monitoring, and the condition mainly affects older people who may have other health issues, care is individualised. The reassuring message is that bullous pemphigoid is a treatable condition — the blistering and itching can be well controlled with treatments that calm the immune response — and that, although it is often a long-term condition, it settles over time in many people.