Bullous Pemphigoid in afya

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over 70yr
skin and occ mouth
autoimmune to layer holding epidermis and dermis together
may be itchy, tense blisters
Biopsy useful to be certain as long term treatment with strong drugs with immunoflourescence - direct (normal skin in Michelles medium) or indirect (serology)

Mx - topical steroid may be enough, else oral steroid,
Azathioprine, Tetracycline, Dapsone, Nicotinamide with Doxycycline

Automimmune - Abs to hemidesmosomal protein BP 180 and BP 230
sub-epidermal blistering
more common in elderly
itchy tense blistering typically around flexures, heal without scarring
no mucosal involvement (well 10% but not in exams !) (mucoSal involved in PemphiguS)
Skin Bx - include for IMF - shows IgG and C3 at dermoepidermal junction
 
Mx
refer dermatology for Bx
oral steroids
also topical steroids, immunosuppressants and antibiotics

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