Bullous pemphigoid is an acquired disease of flaccid blisters ap-pearing on normal or erythematous skin. It appears more often on the flexor surfaces of the arms, legs, axilla, and groin. Oral lesions, if present, are usually transient and minimal. When the blisters break, the skin has shallow erosions that heal fairly quickly. Pruritus can be intense, even before the appearance of the blisters. Bullous pemphigoid is common in the elderly, with a peak in-cidence at about 60 years of age. There is no gender or racial pre-dilection, and the disease can be found throughout the world.
Medical treatment includes topical corticosteroids for localized eruptions and systemic corticosteroids for widespread involvement. Systemic prednisone may be continued for months, in alternate-day doses. The patient needs to understand the implications of long-term corticosteroid therapy, including loss of bone mass, osteoporosis, cataracts, peptic ulcers, psychotic reactions, increased risk for infection, weight gain from fluid retention, and the poten-tial for adrenal suppression.