Bullous pemphigoid is a rare skin condition that causes itching, redness, and blisters. It can take several years and sometimes causes serious problems, but treatment can help. You can find more information below.

What is bullous pemphigoid?

Bullous pemphigoid is a rare skin disease that causes large, fluid-filled blisters. It develops in areas of skin that often stretch, such as the lower abdomen, upper thighs, or armpits. Bullous pemphigoid is more common in older adults.

Bullous pemphigoid occurs when your immune system attacks a thin layer of tissue under your outer skin layer. Although the cause of this abnormal immune response is unknown, it can sometimes be triggered by taking certain medications.

Bullous pemphigoid usually goes away on its own within a few months, but it can take up to five years to resolve. Treatment usually helps heal the blisters and relieve itching. Treatment may include corticosteroid drugs such as prednisone and other drugs that suppress the immune system. Bullous pemphigoid can be life-threatening, especially for older people who are already in poor health.

Causes of bullous pemphigoid

Blisters appear due to a malfunction in your immune system. Your body’s immune system normally produces antibodies to fight bacteria, viruses, or other potentially harmful foreign substances. For reasons that are not clear, your system may develop an antibody against a certain tissue in your body.

In bullous pemphigoid, the immune system produces antibodies to the fibers that connect the outer layer of skin (epidermis) and the next layer of skin (dermis). These antibodies trigger inflammation that produces blisters and itching.

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Other factors

This condition often occurs randomly with no clear contributing factor to the onset of the disease. In some cases, it can be triggered by:

  • Medications: Prescription medications that can cause bullous pemphigoid include etanercept, sulfasalazine, furosemide, and penicillin.
  • Light and radiation: Things like ultraviolet light therapy to treat certain skin conditions, radiation therapy to treat cancer can trigger this condition.
  • Medical conditions: Disorders that can trigger this condition include psoriasis, lichen planus, diabetes , rheumatoid arthritis , ulcerative colitis , and multiple sclerosis .

Who is at risk?

This condition is most common in older adults and the risk increases with age.

Symptoms of bullous pemphigoid

Symptoms of bullous pemphigoid may include:

  • Itching of the skin weeks or months before the blisters form
  • Large blisters that do not tear easily when touched, usually along creases or folds in the skin
  • The skin around the blisters is reddish or darker than normal
  • Eczema or a hives-like rash
  • Small blisters or sores in the mouth or other mucous membranes

When should you see a doctor?

It is a good idea to see your doctor if you experience the following:

  • unexplained blisters
  • blisters in your eyes
  • signs of infection

Bullous pemphigoid diagnosis

To confirm the diagnosis, your doctor may order blood tests and perform a skin biopsy, taking a small sample of the affected skin for laboratory testing. Your doctor may refer you to a doctor who specializes in the skin (dermatologist) or eyes (ophthalmologist), depending on your symptoms and the results of your lab tests.

Bullous pemphigoid treatment

Treatment focuses on healing the skin and relieving itching while minimizing the negative side effects of medications. Your doctor will likely prescribe one or more of the following combinations of drugs:

  • Corticosteroids: The most common treatment is prednisone, taken in pill form. But long-term use can increase your risk of weak bones, diabetes, high blood pressure, high cholesterol and infections. Corticosteroid ointment can be rubbed onto your affected skin and causes fewer side effects.
  • Steroid sparing drugs: These drugs affect the immune system by inhibiting your body’s production of disease-fighting white blood cells. Examples include azathioprine and mycophenolate mofetil. If your symptoms involve the eyes or upper digestive tract, rituximab may be used if other approaches have not helped.
  • Other drugs that fight inflammation: An example of these drugs is methotrexate.
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Remember, your doctor will decide which medicine to take and how.

Lifestyle and home remedies

If you have bullous pemphigoid, you can help care for your condition with the following self-care strategies:

  • Wound care: Follow your doctor’s recommendations for the daily care of blisters.
  • Limit activities if necessary: Blisters on the feet and hands can make it difficult to walk or participate in daily activities. You may need to change your routine until the blisters are under control.
  • Avoid sun exposure: Avoid prolonged sun exposure on any area of ​​skin affected by bullous pemphigoid.
  • Wear loose cotton clothing: This will help protect your skin.
  • Watch what you eat: If you have blisters in your mouth, avoid eating hard and crunchy foods such as chips, raw fruit and vegetables, as such foods can aggravate symptoms.


Bullous pemphigoid usually disappears within 5 years and usually responds well to treatment. However, blisters that rupture and become infected can lead to a life-threatening condition called sepsis . That’s why it’s important to seek treatment at your first symptoms.

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