Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Bullous pemphigoid is a skin disease characterized by tense blistering
eruptions on the surface of the skin. Occasionally, the inner lining tissue of the mouth (mucous membrane tissue) can be involved. The condition is caused by antibodies and inflammation
abnormally accumulating in a certain layer of the skin or mucous membranes. This layer of tissue is called the
"basement membrane." These antibodies (immunoglobulins) bind to proteins in the basement membrane called hemidesmosomal BP antigens and this attracts cells of inflammation.
A majority of cases of bullous pemphigoid occur in people 50 years of age or older. While the cause is unknown, it is felt by some that an aging immune system may become activated in certain individuals with some genetic predisposition to develop bullous pemphigoid.
What are symptoms of bullous pemphigoid?
Symptoms of bullous pemphigoid include intense itching and burning sensation of the skin. When the mucous membranes of the mouth are affected, it can cause pain, burning, and sensitivity to acidic foods. Eating can be difficult, and involvement in the deeper areas of the throat can cause coughing. Involvement of the inner nose can cause nosebleeds.
How is bullous pemphigoid diagnosed?
Bullous pemphigoid is diagnosed based on the
results of a biopsy of involved tissue. The biopsy can reveal the abnormal antibodies
deposited in the basement membrane layer of skin or mucous membrane tissue.
Bullous pemphigoid-like condition can sometimes be associated with
other illnesses, including systemic lupus erythematosus (SLE or
lupus) and cancer.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
A skin biopsy is the removal of a piece of skin for the purpose of further
examination in the laboratory using a microscope. Skin biopsies are performed to
diagnose a number of conditions.
Why is a skin biopsy performed?
Skin biopsy is most frequently done to diagnose a skin growth such as a mole,
or a skin condition such as a rash. A skin biopsy can also be used to diagnose a
cancer of the skin. A skin biopsy may be indicated when a mole or other marking
on the skin has changed in its shape, color, or size. A skin biopsy is also
sometimes used to diagnose infections of the skin.
What methods are used to obtain a skin biopsy?
Different techniques are used in different situations. Typically the biopsies
are obtained using local anesthetics.
A shave biopsy takes a thin slice off the
top of the skin and can be used to remove superficial abnorm...
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