clinical features

Last reviewed 01/2018

Phemphigoid is a nonscarring blistering disease.

Presentation is with large, tense, itchy blisters on a normal or erythematous base (1). They usually occur on the upper arms and thighs and may spread to the trunk. Lesions may be 2-5 cm in diameter. They are thick walled and may last for several days. Initially, their constituent fluid is clear but soon becomes cloudy or haemorrhagic. The blisters may be broken due to excoriation, but unlike in pemphigus, heal quickly. Mucous membrane involvement can be seen in around 50% of the patients. Oral lesions, which occur in about one-third of patients are located mostly on the palatal mucosa (1), but are seldom the presenting feature.

Diagnosis in the early stages may be difficult as blistering is often preceded by widespread pruritus, urticaria and erythema (1).

Circatrical pemphigoid is a variant with only mucous membrane involvement and healing with scarring. Blisters are common on the eyes where they may result in blindness.

Reference:

• 1. British Association of Dermatologists 2002. Guidelines for the management of bullous pemphigoid
• 2. Beissert S et al. A Comparison of Oral Methylprednisolone Plus Azathioprine or Mycophenolate Mofetil for the Treatment of Bullous Pemphigoid. Arch Dermatol. 2007; 143(12):1536-1542
• 3. Langan S.M. et al. Bullous pemphigoid and pemphigus vulgaris-incidence and mortality in the UK: population based cohort study. BMJ 2008; 337:a180