Bullous pemphigoid

• In elderly
• Benign disease, responds well to treatment
• Most common autoimmune bullous disease
• Pathomechanism
  • Autoantibodies against hemidesmosomes
• Clinical features
  • Prodromal stage
    • Weeks before onset of blistering
    • Urticarial lesions
  • Large, tense, subepidermal bulla
    • Don’t rupture easily
  • Intensely pruritic
  • Lower limbs, axilla
  • Rarely oral involvement
• Diagnosis
  • Negative Nikolsky
  • Histology and immunofluorescence
• Treatment
  • Prednisone (0,5 – 1 mg/bwkg)
  • Azathioprine, immunosuppressants