What is Bullous Pemphigoid?

Bullous pemphigoid is a chronic and autoimmune disorder that is characterized by blisters on the skin. The other body part that is affected of this skin problem is the mucous membranes or our mouths.

This skin disorder, bullous pemphigoid, is a rare condition that its frequency of occurrence is unknown to the public in the United States. But this skin problem is said to be reported in France and Germany, making Europe to have bullous pemphigoid the most common autoimmune blistering disease. The incidence of bullous pemphigoid was found to be in the number of 4 cases per 100,000 persons a year in the UK. There has been no racial preference for bullous pemphigoid. Bullous pemphigoid also affects men and women equally. The condition is also reported to affect those who are elderly; an average onset of 65 years is noted. This is a rare condition to the young and children. Others are alarmed if this condition can be transmitted from one person to another. The answer is no, for the condition is an autoimmune disorder, where one only acquires because of an abnormal immune action.

Bullous Pemphigoid Symptoms

The initial signs and symptoms of this skin disease is said to be small patches of an itchy skin. It is observed that the blisters shall burst after several days but then heals. The itchiness would usually be sensed as burning sensation. The blisters are firm in shape and are dome-like in structure. When the mouth is affected, the person shall experience burning sensations in the mucous membranes and shall be sensitive to acidic foods. When the blisters break in the mouth, they form to erosions similar to mouth ulcers. Unfortunately, this skin problem can stay long in a person’s system, even taking up at least a year or so. This skin disorder has several other characteristics and shall be discussed below:

Generalized bullous pemphigoid

This is the most common characteristic of the skin disease. There are bullae or blisters that are filled with fluid which sprout at any skin surface. The oral mucosa is rarely affected and is considered minor. Scars are not usual and should not be a worry to the affected.

Vesicular bullous pemphigoid

This is a less common type of BP. This usually manifests groups of small, tense blisters.

Vegetative bullous pemphigoid

It is a rare form that involves vegetating plaques in the areas of the skin such as the armpits, neck, groin and mammary areas.

Generalized erythroderma bullous pemphigoid

This skin disorder would usually resemble psoriasis. There is generalized atopic dermatitis with various developing vesicles or bullae.

Urticarial bullous pemphigoid

This type of BP would usually start with persistent urticarial (skin rash that are pale red) lesions that would then develop into bullous eruptions. Others would only have urticarial lesions apart from bullous eruptions.

Nodular bullous pemphigoid

This is a rare presentation of BP that clinical feature and resembles itself with blisters arising from a nodular lesion skin.

Arcal bullous pemphigoid

Usually, a childhood-onset is found for this condition due to vaccination. The bullous lesions would usually sprout on the palms, soles of the feet and the face.

Infant bullous pemphigoid

The infants are not spared of this skin disease. Usually the blisters occur on the palms, soles, face while the genitals are areas rarely affected too.

Bullous Pemphigoid Causes

The development of an autoimmune disorder is again a wonder to all of us. This skin condition is idiopathic, meaning from an unknown cause. The mechanism of an autoimmune disorder is to attack one’s own body defenses making a person susceptible to disorders such as bullous pemphigoid. There are also triggering factors for this skin condition and it includes ulcerative colitis and multiple sclerosis. Medication such as furosemide, NSAIDs, captopril, penicillamine, radiation therapy and ultraviolet radiation are supposedly said to cause this condition.

Bullous Pemphigoid Diagnosis

As this condition is left untreated and uncared for, it shall persist for months and even years with periods of remissions then exacerbations. It is very important that one should seek medical help as soon the condition is found out and diagnosed. The diagnosis of the skin ailment is done through a skin biopsy. The serum antibody titers would also identify for the presence for certain antigens for bullous pemphigoid. This can be differentially diagnosed because this condition is usually associated with other skin disorders such as SLE and skin cancer. The antibody can also be detected in one’s urine or in blister fluid.

Bullous Pemphigoid Treatment

The aim of the treatment for bullous pemphigoid is to suppress one’s own immune system. Since the condition involves the immune process, return of the normal funcitioning of the immune system is a must. Here are the following treatments for bullous pemphigoid:

Steroids

These would include prednisolone, known as a traditional treatment for BP. The mechanism of steroids is to reduce the inflammation and suppress the immune system. Initial treatment for this condition should be in high dose for to readily act on the blisters and clear them up. Low dose can be provided as the symptoms have subsided as it is used as maintenance and a control of the symptoms. This type of drug can be in creams or known as a topical steroid cream. This is only recommended to apply on small area of blisters and not on extensive blisters. Any type of BP is suitable for this condition. The conjunction of oral and cream steroids is very much appreciated.

Antibiotic creams or tablet

This can be very helpful in avoiding and treating infections. It is a possibility for this can reduce or avoid another problem. Tetracycline is recommended as well as nicotanamide. Dapsone and erythromycin are recommended also for this condition.

Clean the blisters frequently

Wound care should be done in order to avoid worsening of the condition. This can also avoid infections.

Other immunosuppressant

These would help in suppressing the immune system but has untoward effect for it can make the person susceptible to infections. But the good part is that the person shall attain reduction of the blisters and inflammation. These are the recommended drugs: azathioprine, methotrexate, and mycophenolate mofetil.

Prognosis

The prognosis of this skin condition is good especially when the person affected is very much compliant with the treatment provided for. It is believed that bullous pemphigoid would fully go away after 1 to 5 years, along with the treatment. As this is attained, treatment for bullous pemphigoid is stopped. But there are rare instances where the skin problem can lead to death. This is because a person affected has not been compliant with the treatment course and has contracted an infection. When the infection was not controlled it is truly a possibility that the person can die of sepsis. Better consult a doctor when a skin condition has sprouted to avoid the downside of the disease.

Bullous Pemphigoid Pictures

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What is Dyshidrotic Eczema?

Dyshidrotic eczema is a type of skin disease under eczema. This is again from an unknown cause that is typically characterized by a pruritic vesicular eruption on the fingers, palms and soles of the feet. This skin disorder usually affects teenagers and adults in an acute manner, but can be recurrent or chronic too. This skin condition has alternate names depending on the areas it has affected. It is called cheiropompholyx once the hands are affected. Pedopompholyx when the feet are affected. Other alternate names are pompholyx, keratolysis exfoliativa or vesicular eczema. The term pompholyx is derived from a Greek word meaning bubble, because it’s generally characterized by deep-seated itching blisters.

In the United State, this skin problem usually affects about 5-20% of patients who have had eczema. This commonly affects those people who live in warm areas and sprouts during spring and summer seasons. The condition is said to be affecting men and women equally. A mean age of 38 years is the age demographic for dyshidrotic eczema. This condition is believed to peak at the age of 20 to 40 years.

This condition is diagnosed by a simple physical examination. A thorough investigation of the patient’s familial history can also provide support for the diagnosis of the disease. Skin biopsy is also done to rule out other possible conditions.

Dyshidrotic Eczema Symptoms

The usual complaints of the affected individuals are the following:

• Pruritus of the hands and feet with sudden onset of vesicles
• Burning sensation, usually before the vesicles appear
• Tiny vesicle erupt along the lateral aspect of the fingers, then on the palms and soles of the feet
• Palms and soles may become reddish and wet with perspiration
• These vesicles usually last for three to four weeks

It has been reported that about 80% of dyshidrotic eczema patients’ experiences hands affectations while about 10% of cases are those who experience feet eczema. One should seek medical help when the condition has worsened and have come to a state of severe tenderness, redness, warmth and onset of fever. These are signs of infection.

Dyshidrotic Eczema Causes

This idiopathic skin disorder is believed to be linked with hypothetical suggestions. These are the following etiological link for dyshidrotic eczema:

Sweat gland dysfunction

This has been quite disputed among researchers for vesicles have not been associated with sweat ducts. Sweaty hands are a trigger for this skin dysfunction.

Genetics

This plays a role in monozygotic twins (identical). It is believed that mutation on the filaggrin gene can lead to loss of filaggrin, causing dyskeratinization.

Atopy

This has been reported that those with familial atopic diathesis (eczema, asthma, hay fever and allergic sinusitis) are commonly affected. This has been reported that this skin disorder is a first manifestation of an atopic diathesis.

Nickel sensitivity

In some studies, nickel sensitivity was elevated in dyshidrosis patients.

Cobalt sensitivity

Oral ingestion of cobalt would usually manifest systemic allergic dermatitis as to dyshidrotic eczema.

Exposure to sensitizing chemicals

This can lead to dyshidrotic eczema outbreaks. These are from chemical and metals such as chromium, cobalt, carba mix, fragrance mix.

Fungal infection

Existence of an underlying skin infection can precipitate to the development of another form of skin disease.

Other possible triggers

Deodorant soaps, strong detergents, emotional stress, and use of rubber or latex gloves on the skin.

Underlying chronic disorder such as HIV can result to this condition.

Dyshidrotic Eczema Treatment

There is no ultimate cure for this condition; instead the aim of the treatment course is to stabilize the patient’s symptoms. In order to avoid the worsening of the disease here are some helpful tips to follow:

• Avoid scratching the hands. This can only worsen the state of the skin problem.
• Take oral antihistamines. This can provide relief from the itchiness and can also facilitate sleep.
• Ointment or creams. These are best applied two times a day and every after hand washing. Petroleum jelly is best to avoid dryness and to reduce itchiness.
• Apply corticosteroid cream or ointments. These are helpful in reducing the inflammation. These creams include tacrolimus or pimecrolimus.
• When the condition has come to a point that it cannot be controlled, steroid pills are provided.
• Jewelry or rings can house bacteria. Usual cleaning and disinfecting them can avoid you the harm of having this skin condition.
• After washing hands dry them and apply a moisturizer so to avoid dryness.
• Cotton gloves are recommended. The use of water-proof gloves is not suitable especially when a person has already developed the skin disorder.

In order to attain good prognosis, one should be compliant with the treatment provided for. The doctor’s order should be followed accordingly. Even though there is no definite cure for this skin disorder, the symptoms can be controlled by following the steps above. We can also avoid complications such as severe pain and secondary bacterial infections if we follow the following guidelines above.

Is Dyshidrotic Eczema Contagious?

Most people would ask, is this contagious? Well, the answer is no. This skin disorder is genetically acquired that does not affect the people who have come to touch or feel another person’s dyshidrotic eczema. Others would conclude that this condition is contagious because of its physical presentation but it’s generally not. Proper health information and education is very essential so that a social stigma is not presented to those affected of dyshidrotic eczema.

Dyshidrotic Eczema Pictures

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