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Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

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.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• What is bullous pemphigoid?
• What are symptoms of bullous pemphigoid?
• How is bullous pemphigoid diagnosed?
• What is the treatment for bullous pemphigoid?
• What is the prognosis of bullous pemphigoid?
• Patient Comments: Bullous Pemphigoid - Experience
• Find a local Dermatologist in your town
• Bullous Pemphigoid Index

Bullous pemphigoid can be chronic and mild without substantially disturbing the general health of affected individuals. It can also terribly affect daily lives in its more severe forms. Mild bullous pemphigoid can resolve with topical cortisone creams but sometimes requires high doses of cortisone ("steroids") taken internally. Severe bullous pemphigoid can also require immune-suppression drugs such as azathioprine (Imuran), mycophenolate (Cellcept), and methotrexate (Rheumatrex). Tetracycline has also been used as an option to reduce inflammation. Other treatments that have been used for severe disease include intravenous immunoglobulin infusions, typically given monthly.

Research has indicated that large quantities of high-potency topical corticosteroids applied to the entire body surface were safer and more effective in controlling extensive bullous pemphigoid than oral corticosteroids. It was felt by the researchers that topical corticosteroids should now be the treatment of choice for bullous pemphigoid, particularly when the disease is not extensive.

The outlook for bullous pemphigoid is variable. As described above, the symptoms tend to wax and wane. In its most severe form it can be fatal without treatment, especially if involving the airways and pharynx.

REFERENCE:

Leiferman, Kristin M., et al. "Epidemiology and pathogenesis of bullous pemphigoid and mucous membrane pemphigoid." UpToDate. 12 Dec. 2012.