Bullous pemphigoid: Overview

Bullous pemphigoid is a chronic disease, which means it lasts longer than six weeks. For many people, this disease lasts for months or years. As older blisters open and crust over, new blisters can appear.

While bullous pemphigoid is known for causing large blisters, you may notice changes to your skin before the blisters appear for the first time. This disease can begin with itchy skin. For some people, the itch feels intense and makes it hard to sleep.

Bullous pemphigoid on a patient’s arm

This disease causes blisters, which often develop on skin that itches.

You may also develop a rash before you see the first blisters. This rash often looks like welts or raised patches on the skin. The rash can appear in one or two places on your skin or be widespread. The rash often itches.

Although bullous pemphigoid is a disease that causes blisters, some people only develop itching and a rash. It’s also possible to develop blisters and never see a rash.

If you develop blisters, the blisters tend to come and go. You could have new blisters every day. Other times, the disease calms down, so you may not see blisters for a while.

Treatment can prevent (or reduce) itching, rash, and how many new blisters you get. When this happens, the disease is said to be in remission.

A remission differs from a cure. When a disease goes into remission, the signs and symptoms either disappear or decrease noticeably. A disease in remission can come back.

It can take time for treatment to send bullous pemphigoid into remission. If the disease covers a large area or has been around for years, remission can take a year or longer.

It can also take time to find a treatment that works for you. Some people try a few different treatments before one works.

Although rare, dermatologists are seeing more patients with this disease. It’s believed that this is happening for two reasons:

1. People are living longer, so they’re more likely to develop this disease, which often begins after 60 years of age.

2. Some newer medications that treat diabetes, cancer, and other diseases may trigger bullous pemphigoid.

If you have blisters that come and go, itching all over your body, or other signs of bullous pemphigoid, it’s important to see a dermatologist. Left untreated, this disease can lead to a serious infection or other life-threatening medical condition.

You’ll find the symptoms often caused by bullous pemphigoid, along with more pictures of bullous pemphigoid, at: Bullous pemphigoid: Signs and symptoms.

Image
Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References
Bernard P, Borradori L. “Pemphigoid group.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018: 510-9.

Brick KE, Weaver CH, et al. “Incidence of bullous pemphigoid and mortality of patients with bullous pemphigoid in Olmsted County, Minnesota, 1960 through 2009.” J Am Acad Dermatol. 2014;71(1):92-9.

Culton DA, Zhi L, Diaz LA. “Bullous pemphigoid.” In: Kang S, et al. Fitzpatrick’s Dermatology. (ninth edition) McGraw Hill Education, United States of America, 2019:944-55.

Grantham HJ, Stocken DD, et al. “Doxycycline: a first-line treatment for bullous pemphigoid?” Lancet. 2017 Apr 22;389(10079):1586-8.

Han A. “A practical approach to treating autoimmune bullous disorders with systemic medications.” J Clin Aesthet Dermatol. 2009 May;2(5):19-28.

Heymann WR. “Targeted anti-complement therapy may prove to be a complementary treatment for bullous pemphigoid.” Dermatol World Insights & Inquires. 2020;2(40).

Yosipovitch G and Kwatra SG. “Itch associated with autoimmune disorders.” In: Living with itch: A patient’s guide. The Johns Hopkins University Press. United States of America, 2013: 63-5.

Written by:
Paula Ludmann, MS

Reviewed by:
Arturo R. Dominguez MD, FAAD
Ivy Lee, MD, FAAD
Shari Lipner, MD, PhD, FAAD

Last updated: 9/21/21