Ver el código de «Bullous pemphigoid»

==Background==
{{Skin anatomy background images}}
*Chronic autoimmune blistering disease 
*Blisters occur deep, within the epidermal basement membrane
*Bullae evolve over weeks to months

===Risk factors===
*Age > 60
*Female
*Malignancy
*[[Furosemide]]

==Clinical Features==
[[File:bullous pemphigoid.JPG|thumbnail]]
*Bullae commonly occur in the axillae, abdomen, inner thighs, flexural forearms, and lower legs<ref>http://emedicine.medscape.com/article/1062391-overview</ref>
*May be intensely [[pruritus|pruritic]]
**Start with [[urticaria|urticarial]] lesions
**Then tense blisters/bullae up to 10 cm
*'''Nikolsky sign negative'''
*Reported after UV/radiation therapy, drugs: furosemide, NSAIDs, captopril, antibiotics, vaccinations
*Involves mucosa in 10-25%, may limit PO intake

==Differential Diagnosis==
{{Bullous rashes DDX}}

==Management==
*'''[[Antihistamine]]''' for pruritus
*'''Anti-inflammatory''' agents options
**Oral [[corticosteroids]] such as [[prednisone]] 50mg PO daily
**[[Tetracycline]] 1.5-2 g/day with nicotinamide 1.5-2 g/day 
**[[Dapsone]] 50mg daily
**High potency [[topical steroids]] such as [[clobetasol]] 
*''Topical corticosteroids may offer similar treatment effect as oral steroids with less systemic effects.''<ref>Joly P, Roujeau JC, Benichou J, et al. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med. Jan 31 2002;346(5):321-7. [Medline].</ref><ref>Terra JB, Potze WJ, Jonkman MF. Whole body application of a potent topical corticosteroid for bullous pemphigoid. J Eur Acad Dermatol Venereol. Apr 3 2013;[Medline]. </ref><ref> 2. Gual A, Iranzo P, Mascaró Jr JM. Treatment of bullous pemphigoid with low-dose oral cyclophosphamide: a case series of 20 patients. J Eur Acad Dermatol Venereol. Apr 13 2013;[Medline].</ref>
*Immunosuppressants (eg, [[azathioprine]], [[methotrexate]], [[mycophenolate mofetil]], [[cyclophosphamide]]). 
*IVIG is effective in bullous pemphigoid and can be given every 4 weeks, making it a feasible option for those with poor social support and/or limited access to healthcare or housing
*Most will require therapy for 6-60 months, mortality associated with disease usually secondary to medications
*Derm referral for diagnosis via biopsy

==References==
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==See Also==
*[[Fever and Rash]]
*[[Visual diagnosis (main)]]

[[Category:Dermatology]]