Bullous pemphigoid

Last reviewed: 26 Aug 2022
Last updated: 11 Dec 2020

Summary

Definition

History and exam

Key diagnostic factors

  • pruritus
  • tense blisters on normal or erythematous skin
More key diagnostic factors

Other diagnostic factors

  • erythematous or urticarial plaques
  • oral lesions
Other diagnostic factors

Risk factors

  • age 60 to 90 years
  • major histocompatibility complex (MHC) class II allele (DQB1*0301)
  • male sex
More risk factors

Diagnostic investigations

1st investigations to order

  • skin biopsy for histopathologic evaluation with light microscopy
  • skin biopsy for direct immunofluorescence testing
  • indirect immunofluorescence test on serum
More 1st investigations to order

Investigations to consider

  • ELISA test
More investigations to consider

Emerging tests

  • immunoblotting
  • immunoprecipitation
  • fluorescence overlay antigen mapping (FOAM) technique

Treatment algorithm

ACUTE

localized lesions in children or adults

widespread lesions in adults

widespread lesions in children

Contributors

Authors

Vesna Petronic-Rosic, MD, MSc, MBA

Professor and Chair

Department of Dermatology

Georgetown University

MedStar Washington Hospital Center

Washington

DC

Disclosures

VPR declares that she has no competing interests.

Peer reviewers

Lawrence Parish, MD

Clinical Professor of Dermatology and Cutaneous Biology

Director

Jefferson Center for International Dermatology

Jefferson Medical College

Thomas Jefferson University

Philadelphia

PA

Disclosures

LP declares that he has no competing interests.

Timothy Patton, MD

Assistant Professor of Dermatology

Department of Dermatology

University of Pittsburgh

Pittsburgh

PA

Disclosures

TP declares that he has no competing interests.

  • Bullous pemphigoid images
  • Differentials

    • Pemphigus vulgaris
    • Epidermolysis bullosa acquisita
    • Linear IgA dermatosis
    More Differentials
  • Guidelines

    • Guidelines for the management of bullous pemphigoid
    More Guidelines
  • Calculators

    Karnofsky Performance Status Score

    More Calculators
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