How is it different from pemphigus?
The difference is at what level tissue adhesion is destroyed. In pemphigus, antibodies destroy the contacts between cells inside the epidermis, so the blisters are flaccid, with a thin cover, and the mouth almost always suffers. With pemphigoid, the target becomes the zone of attachment of the epidermis to the dermis, the bubble is deeper, its cover is the entire epidermis, so it is dense, tense, persists for a long time and heals without a scar. The itching with pemphigoid is usually severe; with pemphigus, the leading complaint is pain. The age of the patients also varies.
- A bubble forms under the epidermis, the tire is dense
- The blisters are tense and do not open for a long time
- The oral mucosa is rarely affected
- Severe itching is a typical complaint.
- Healing without scars
- Mostly older people get sick
Causes and provoking factors
The disease is associated with the formation of antibodies to proteins in the basement membrane of the skin, but what exactly triggers this process is not completely clear. There is a clear connection with old age and neurological diseases: stroke, dementia, Parkinson's disease, multiple sclerosis. Medicines are of particular importance: pemphigoid can develop while taking a number of medications, including some hypoglycemic and diuretics, so the doctor always checks the full list of medications taken. Provoking factors also include skin injuries, burns, and radiation therapy.
- Antibodies to skin basement membrane proteins
- Old age
- Stroke, dementia, Parkinson's disease
- Taking certain medications
- Skin injuries, burns, radiation therapy
- Limited mobility and prolonged pressure on the skin
Symptoms
The disease often begins nonspecifically: persistent itching appears, sometimes painful, with red, swollen spots and blisters, reminiscent of hives or eczema. This stage can last weeks or months, and it is during this time that the diagnosis is most often missed. Then, against the background of spots or on unchanged skin, large tense blisters with transparent, sometimes bloody contents appear. Favorite places are the stomach, inner thighs and shoulders, folds, bends of the arms and legs. After opening, erosions remain that heal without leaving scars.
- Severe itching long before blisters appear
- Red, swollen spots and blisters
- Large, tense blisters with dense lining
- Clear or bloody contents
- Localization on the abdomen, hips, folds and folds
- Healing erosions without scars
Diagnostics
The main method is biopsy. Material is taken from the fresh blister for histology, and from apparently healthy nearby skin for direct immunofluorescence, which shows antibody deposits along the basement membrane. This study distinguishes pemphigoid from pemphigus. Specific antibodies are determined in the blood, their level helps to monitor the activity of the disease. A complete blood count often reveals an increased number of eosinophils. Be sure to clarify the list of medications taken and evaluate concomitant diseases, since hormonal therapy is required in an elderly person.
- Biopsy of a fresh bladder with histology
- Direct immunofluorescence of the skin near the lesion
- Blood test for specific antibodies
- Complete blood count with eosinophil assessment
- Review of medications taken
- Assessment of sugar, blood pressure and related diseases
Treatment and care
With limited damage, strong external hormonal agents applied to the entire affected surface are often sufficient - this approach is safer for an elderly person than pills. In the common form, systemic glucocorticoids are prescribed, sometimes in combination with antibiotics that have an anti-inflammatory effect or with drugs that suppress the immune system. All schemes are selected by the doctor. Care is no less important: large blisters are carefully opened in a clinical setting, keeping the tire as a natural dressing, erosions are treated with antiseptics, and the skin is moisturized. A separate task is to control itching and prevent infection.
- Strong external hormonal agents on affected areas
- Systemic glucocorticoids in the common form
- Antibiotics with anti-inflammatory action according to the doctor's decision
- Immunosuppressive therapy for persistent disease
- Careful opening of large blisters in the clinic and antiseptic treatment
- Cancellation or replacement of the drug that caused the disease, only with a doctor