dermatologic disorders
Bullous Pemphigoid
Symptoms and Signs of Bullous Pemphigoid
Pruritus is the first symptom of bullous pemphigoid. Skin lesions may not develop for several years. Often, characteristic tense bullae develop on skin of the trunk and in the flexural and intertriginous areas. Bullae may develop on normal-appearing skin or may be preceded by erythematous or urticarial-appearing plaques. Localized disease may occur at trauma sites, stomas, and anogenital and lower leg areas. Dyshidrotic pemphigoid is a rare form of bullous pemphigoid that affects the hands and feet and can look like dyshidrotic dermatitis (a form of Hand and Foot Dermatitis ) on the palms. Bullae usually do not rupture, but those that do often rapidly heal. Polymorphic, annular, dusky-red, edematous lesions, with or without peripheral vesicles, can occur. Rarely, small blisters develop on the mucosa. Leukocytosis and eosinophilia are common, but fever is rare. The Nikolsky sign, where upper layers of epidermis move laterally with slight pressure or rubbing of skin adjacent to a blister, is negative. This photo shows tense bullae, erosions, and crusts on the arm of a patient with bullous pemphigoid. © Springer Science+Business Media This photo of a patient with bullous pemphigoid shows erythematous plaques with intact bullae and erosions on the lateral and dorsal foot. Image provided by Thomas Habif, MD. This image shows ruptured bullae and erosions on the thigh of a person with bullous pemphigoid. Image courtesy of Karen McKoy, MD. This photo shows ruptured and unruptured bullous lesions on an erythematous base. Image courtesy of Daniel M. Peraza, MD. 