​Dermatology - Bullous pemphigoid

​Dermatology - Bullous pemphigoid 
Bullous pemphigoid is an autoimmune disease that mostly affects older people.

When the disease first starts, it usually looks like a prodromal eruption with itchy, papular sores. After a few weeks or months, it changes into bullae that can show up all at once as a generalized outbreak. At first, there were no symptoms except for mild to severe itching. Later, the eroded lesions became painful. There are no constitutional signs, unless the disease is widespread and very bad.
Skin sores
Lesions that are erythematous, papular, or urticarial may show up months before bullae form.
There are small to large bullae that are tense, have a hard top, and are oval or round. They can appear on normal, erythematous, or urticarial skin and contain serous or hemorrhagic fluid. The explosion could be localized or widespread, and it could be spread out or grouped in arciform or serpiginous patterns. When bullae break, big, bright red erosions that ooze and bleed can become a big problem. Bullae are usually tight at first, but they fall apart and turn into crusts.

It can be distinguished from other bullous illnesses based on its clinical presentation, histopathology, and immunocytochemistry.

Systemic prednisone can often lead to recovery that lasts for good. Starting amounts of 50–100 mg/day are kept up until the patient is clear. This can be taken with azathioprine, 150 mg every day to start recovery and 50–100 mg every day to keep it going. When other treatments don't work, IVIG plasmapheresis can help. For weaker cases, sulfones (dapsone) at a dose of 100–150 mg/day can help. Methotrexate taken by mouth in low doses (2.5 to 10 mg per week) works well and is safe for older people. In very mild cases and for local recurrences, glucocorticoid or tacrolimus treatment applied to the skin may help.
It has been said that tetracycline plus nicotinamide can work in some situations.