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Bullous pemphigoid: Signs and symptoms


Where does bullous pemphigoid develop on the body?

Bullous pemphigoid is a disease that causes blisters, which can develop anywhere on the skin.

Most people develop blisters on one or more of the following areas:

  • Arms

  • Armpits

  • Legs

  • Abdomen

  • Groin

  • Mouth

The blisters may appear on a few or many areas of the skin. When the blisters develop on many areas, the medical term for this is “widespread.” Widespread blisters appear in many areas like the arms, back, chest, and legs.

One type of bullous pemphigoid develops only on the:

  • Hands (palms) and feet (soles)

Occasionally, some people living with bullous pemphigoid develop blisters:

  • Inside their mouth or throat

What are the signs and symptoms of bullous pemphigoid?

Often beginning after 60 years of age, this disease usually causes a cycle of blisters. As the old blisters clear, new blisters often form.

While bullous pemphigoid is a blistering disease, research shows that about 20% of people who develop this disease never get blisters. Instead, they can have itching, a rash, or both.

The following pictures show what bullous pemphigoid can look like.

Itch

Before the blisters appear for the first time, your skin may itch. Some people have mildly itchy skin. For others, the itch can be intense. The itch can begin weeks (or months) before blisters appear. Sometimes, a few areas itch. Other times, the entire body itches.

Woman scratching arm

Rash may appear, which can last for days or weeks

Along with itchy skin, some people develop a rash that can look like hives (or large welts), as shown here. The rash can also look like a case of itchy eczema.

Rash due to bullous pemphigoid

Blisters appear and can last for days

The blisters can appear on skin with (or without) a rash. The patients shown here developed blisters on their neck. If you have a darker skin tone, the blisters may be dusky pink, brown, or black. In lighter skin tones, the blisters often look yellow, pink, or red.

Bullous pemphigoid blisters on white skin and on black skin

Solid-feeling blisters

Some blisters are large, measuring two inches in diameter. Others will be smaller. Regardless of size, the blisters feel like they’re stretched tight, and the blisters don’t rupture easily when touched.

Large blister of bullous pemphigoid

Blisters rupture on their own

In time, the blisters collapse and crust over. When a blister clears, the skin tends to feel raw and tender. Crusts often form where the blisters had been.

What skin looks like when bullous pemphigoid blisters rupture.

Spots can appear as the blisters clear

As the blisters go away, you may see spots of discolored skin (or tiny, raised, white bumps) where you had the blisters. These spots and bumps aren’t scars. These spots, which may be lighter or darker than your natural skin tone, will fade with time, and so will the tiny, raised bumps.

Spots on skin after bullous pemphigoid blisters clear.

New blisters often continue to appear

Bullous pemphigoid is a chronic disease, which means it can last a long time. For some people, new blisters will continue to appear for years or a lifetime. It’s also possible that the blisters will go away on their own in a few months. Treatment can help reduce flare-ups and ease the itch.

Severe bullous pemphigoid

While bullous pemphigoid is a rare disease, more people are developing it. You can see if you have a higher risk of developing this disease at: Bullous pemphigoid: Causes.


Images
Image 1: Getty Images

Images 2,3,4,6,7,8: Used with permission of the Journal of the American Academy of Dermatology and JAAD Case Reports:

  • J Am Acad Dermatol 2001;45:246-9.

  • JAAD Case Reports 2015;1:359-60.

  • JAAD Case Reports 2020;6:400-2.

  • JAAD Case Reports 2016;2:442-4.

  • J Am Acad Dermatol 2009;60:1042-4.

  • J Am Acad Dermatol 2011;65;1061-3.

Image 5: 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.

Cohen PR. “Dyshidrosiform bullous pemphigoid.” Medicina (Kaunas). 2021 Apr 20;57(4):398.

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.

Qiu C, Shevchenko A, et al. “Bullous pemphigoid secondary to pembrolizumab mimicking toxic epidermal necrolysis.” JAAD Case Reports 2020;6:400-2.

Tull TJ, Benton E. “Immunobullous disease.” Clin Med (Lond). 2021;21(3):162-5.


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

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