How is Bullous Pemphigoid diagnosed?

The diagnosis of BP is made based on the typical presentation of tense blistering rashes, together with the following:

Skin biopsy of a blister for histology (microscope examination).

Biopsy of adjacent normal-looking skin or early lesions for immunofluorescence to check for presence of antibodies in the skin. A small sample (biopsy) of your skin may be taken and tested in a laboratory.

Special blood tests to look for skin antibodies circulating in the blood.

Can Bullous Pemphigoid be treated?

BP can be controlled with medications and may become inactive after a few years.

Treatment is important to prevent complications such as itch, sleep disturbances, skin or blood infections. Medications are needed to relieve itch, stop new blisters from occurring and promote healing of blisters. Lowest possible doses of medications will be used to achieve these.

How do I treat Bullous Pemphigoid?

It cannot be cured, but treatments are usually successful to relieve the symptoms. Symptoms may recur.

Your doctor may prescribe medications such as:

Topical Corticosteroids (either full body application or localised application)
Oral Corticosteroids
Immunosuppressants
Antibiotics
Antihistamines

Medications and Side Effects:

The following are medications which are commonly used in the treatment this blistering disease:

PREDNISOLONE:

Prednisolone is a steroid tablet that affects the immune system. It works fast and is used to get the disease under control quickly. It is usually prescribed as a single morning dose to be taken after food.

Other dosing regime may be given by your doctors according to your needs.

Common non serious side effects of this drug include:

Weight gain
Facial puffiness
Water retention
Episodic blurring of vision

More serious side effects include:

Hypertension
Diabetes mellitus
Osteoporosis
Increased susceptibility to infections
Glaucoma
Cataracts
Depression
Peptic ulcer disease

While on this medication, your doctor will monitor your blood pressure, blood sugar or urine regularly. Bone mineral density scans may also be ordered for you on an annual basis.

DAPSONE:

Dapsone is actually an antibiotic. Its ability to modulate the immune system makes it useful in the treatment of BP. Its use can reduce the steroid requirement to control the disease activity of BP (i.e provide a "steroid-sparing" effect).

AZATHIOPRINE:

Azathioprine is also not a steroid tablet. It is an immunosuppressant, given together with steroids, to provide better control of the disease activity of BP and reduce the steroid dose (provide a "steroid-sparing" effect). Frequent blood tests will be required during the first few weeks of therapy.

Side effects of azathioprine include:

Include increased susceptibility to infections
Suppression of the bone marrow
Liver toxicity
Sterility

DOXYCYCLINE WITH OR WITHOUT NICOTINAMIDE:

This combination may be given for milder cases of BP. Common non-serious side effects of these drugs include:

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Conditions

Treatments