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Bullous pemphigoid

Pemphigoides bullosa · Bulózní pemfigoid

What it is

Antibodies attack the glue between epidermis and dermis, raising large tense blisters — mostly in people over 70.

Symptoms & signs

  • Intense itching, often for months first
  • large tense fluid blisters on the limbs and trunk
  • red hive-like patches
  • blisters rarely in the mouth

🚩 Get help if…

  • call 112 / 911 now Fever with many burst blisters and red, hot, oozing skin
  • see a doctor soon Blisters in the mouth, eyes or genitals
  • see a doctor soon Blisters spreading fast despite treatment
  • see a doctor soon Burst blisters that are painful, crusted yellow or smelly

Where it strikes

Medical treatment

  • Strong steroid cream (clobetasol) over the whole body
  • oral prednisolone
  • doxycycline as a gentler start (BLISTER trial)
  • dupilumab, methotrexate or rituximab for resistant cases
  • review drugs that trigger it (gliptins)

Natural & lifestyle

  • Keep blisters intact, drain large ones with a sterile needle
  • non-adherent dressings
  • moisturise the skin
  • nutrition support

Emerging & experimental

  • Omalizumab (anti-IgE)
  • complement and IL-17 inhibitors
  • efgartigimod

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Nicotinamide with a tetracycline — small studies as a steroid-sparing option early / small studies
  • Oatmeal baths and aloe for itch — soothing; untested anecdotal / traditional
  • Herbal and 'detox' regimens — untested; delaying steroids risks infection of open skin anecdotal / traditional

ICD codes