Bullous pemphigoid: Dr. Antoine Seignez answers all your questions!

Hello Antoine Seignez, you are a Doctor of Pharmacy (PharmD) at Carenity. Thank you for accepting to talk to us about bullous pemphigoid.

First of all, could you please remind us what bullous pemphigoid is and what symptoms it causes? 

Bullous pemphigoid is a rare autoimmune disease that affects the skin. The immune system, the role of which is to protect the body, inexplicably attacks certain parts of the body, in this case the skin, thus causing lesions of various extent. These lesions are most often symmetrical blisters (hence the adjective "bullous") affecting, for example, the left arm and the right arm at the same time; sometimes canker sores also develop in the mouth.

Are there other conditions associated with bullous pemphigoid? 

Bullous pemphigoid is sometimes accompanied by other autoimmune diseases, which could result from the same immune disorders. Patients with pemphigoid sometimes also suffer with multiple sclerosis or psoriasis. Moreover, they are more likely to develop neurological diseases (Alzheimer's disease, etc.).

What are the treatments for bullous pemphigoid? 

Bullous pemphigoid is a potentially fatal disease in frail patients. It is important to take a corticosteroid-based treatment, either topical (cream to be applied daily to the affected areas) or oral. Topical treatment is more limiting but just as effective as and less harmful than oral treatment.

>> Here is an interesting article about corticosteroids! << 

When corticosteroid therapy does not work, which is very rare, more powerful drugs may be prescribed: immunosuppressants.

Bullous pemphigoid normally goes away a few months or years (up to about five years) after the start of treatment.

What is the role of diet in treating bullous pemphigoid?

Extensive skin lesions can lead to dehydration and protein loss. Therefore, it is recommended that patients, especially the elderly, have a balance diet and drink enough liquid. Low-protein diets should be avoided. Meat (including fish), dairy products, soy, lentils, chickpeas, eggs, for example, are rich in protein.

Is psychological care necessary for patients with bullous pemphigoid? 

Although bullous pemphigoid is not contagious, the sight of its lesions can unfortunately provoke a feeling of mistrust and hostility in those around the patients, and uneasiness in the patients themselves. Psychological support may be helpful for patients with severe forms of the disease.

The sun: Is it harmful for patients with bullous pemphigoid? 

To prevent other skin problems, it is recommended that you do not overexpose yourself to sunlight and use sunscreen with a sufficient level of SPF protection, if you have to be in the sun.

>> To learn more about sunscreens and how to choose them correctly, read our article << 

Fatigue: Is it a symptom of bullous pemphigoid? 

Patients suffering with bullous pemphigoid can feel the need to scratch. Severe itching can affect the quality of their sleep. Thus, fatigue is a sign of the severity of the disease. Effective treatment can reduce or even eliminate itching.

Can bullous pemphigoid get infected? 

Lesions can get infected and it can have very serious consequences, as microorganisms (viruses, bacteria) can enter the body through the skin. It is strongly recommended not to burst the blisters: this promotes infections and, moreover, may leave marks on the skin. If an infection is suspected, it is vital to see a doctor as soon as possible, so that he or she could confirm the diagnosis and prescribe antibiotics.

Dr. Seignez, thank you for your answers!