Bullous pemphigoid is an acute or chronic autoimmune skin disease, involving the formation of blisters, more appropriately known as bullae, at the space between the skin layers epidermis and dermis. It is classified as a type II hypersensitivity reaction, with the formation of anti-hemidesmosome antibodies.
In most cases of bullous pemphigoid, no clear precipitating factors are identified. Potential precipitating events that have been reported include exposure to ultraviolet light and radiation therapy. Onset of bullous pemphigoid has also been associated with certain drugs, including furosemide, and other nonsteroidal anti-inflammatory agents, captopril,penicillamine, and antibiotics.
The most common symptom of pemphigoid is blistering that occurs on the arms, legs, abdomen, and mucous membranes. Hives and itching are also common. The blisters have certain characteristics, regardless of where on the body they form: they are often preceded by a red rash, they are large and filled with fluid that is usually clear, but may contain some blood they are thick and do not rupture easily, the skin around the blisters may appear normal or slightly red or dark, ruptured blisters are usually sensitive and painful.
Pemphigoid cannot be cured, but treatments are usually very successful at relieving symptoms. Corticosteroids, either in pill or topical form, will likely be the first treatment your doctor prescribes. These medications reduce inflammation and can help to heal the blisters and relieve itching. However, they can also cause serious side effects, especially from long-term use, so your doctor will take you off of the corticosteroids after the blistering clears up. Another treatment option is to take medication that suppresses your immune system, often in conjunction with the corticosteroids. Immunosuppressants help, but they also put you at risk for other infections. Certain antibiotics, such as tetracycline, may also be prescribed to reduce inflammation and infection.
All patients at the Medical College of Wisconsin Affiliated Hospitals with a new diagnosis of bullous pemphigoid (BP) between May 1, 1997 and September 1, 2002 were included in this study. The age at onset, date of death or date of last follow-up visit, mode of treatment, co-morbidities, and initial and follow-up hospitalizations were noted. Thirty-eight new patients were identified and complete follow-up data were obtained on 37 of the patients. Patients were followed a minimum of 1 y or until the time of death. The mean duration of follow-up was 20 mo. Kaplan–Meier analysis of our population indicated a 1-y survival probability of 88.96% (standard error 5.21%), with a 95% confidence interval (75.6%, 94.2%). This survival rate was considerably higher than that recently reported in several studies from Europe (29%–41% first year mortality). Although the age at onset and co-morbidities of our patients were similar to those in the European studies, the rate of hospitalization of our patients was much lower than that of patients from Europe (1.5 d per patient vs 11–25 d per patient). This study suggests that differences in practice patterns may be an important factor in the reduced mortality rate in US BP patients compared with Europe.