Can pemphigus bullous skin disease be cured?

The article was professionally consulted with Specialist Doctor I Nguyen Thanh Van - Doctor of Internal Medicine - Dermatology - Department of Medical Examination & Internal Medicine - Vinmec Phu Quoc International General Hospital.

Bullous pemphigoid is a bullous skin disease that appears on the skin and mucous membranes, is an autoimmune disease and is common in the elderly. The cause of the disease is unknown and there is no definitive cure. However, we have measures to help treat the disease to avoid frequent infections and recurrences.

Bullous pemphigoid is an autoimmune bullous skin disease, where the blisters are located under the epidermis. The disease is common in the elderly, from 50 to 60 years old, especially over 70 years old, can be seen in young people but is very rare in children.

The cause of the disease is unknown. However, some drugs can cause bullous pemphigoid associated with internal malignancies such as: There is a relationship of the disease to human leukocyte antigen (HLA). The disease is more common in the elderly with neurological diseases, especially stroke, intellectual disability, Parkinson's disease.
In addition, people with psoriasis , people with infected wounds have a higher risk of disease than the general population. In some patients, bullous pemphigoid has been associated with visceral malignancies.

Usually starts with a rash, urticarial papules, lesions are often distributed in many places, common locations are: Lower abdomen, inner thighs, groin, armpits, forearm flexion The most characteristic lesion of Pemphigoid Bullae are large, stretchy blisters that grow on red, inflamed skin or on normal skin. Because it is a sub-epidermal vesicle type, it is usually intact, not broken, often tight and firm. Blisters are fluid-filled, sometimes hemorrhagic, that, when broken into a scaly, crusted area, do not tend to spread around like Pemphigus and generally heal without scarring. Nikolsky's signs of skin rubbing (-) There are also less common forms such as papules or dermatitis-like leeches. Mucosal lesions are uncommon (8-39%) if present, they are usually small blisters in the mouth, difficult to rupture, and cause little pain. Symptoms of itching vary from no itching to severe itching. Systemic symptoms are only present when the disease is severe and the skin lesions are widespread.

Pathology: Subepidermal bullae, with inflammatory infiltrates in the superficial part of the epidermis consisting of eosinophils and few neutrophils.
Direct immunofluorescence: with banded IgG deposition and 90-100% of C3 in the basement membrane of the epidermis.

Definitive diagnosis based on clinical lesions are large, stretchy, non-ruptured bullae growing on the background of inflamed red skin or normal skin, mainly in the lower abdomen, inner thigh, and forearm flexor; often there is itching; there is damage to the oral mucosa; patients 60 years or older, histopathological examination and immunofluorescence.

Apply an antiseptic solution if the lesion is ulcerated, apply antibiotic ointment or corticosteroid ointment when the lesion is dry.

Corticosteroids started at 0.3-1mg/kg/day and used for 1-2 weeks, 70-80% showed a good response after gradual dose reduction and maintenance dose. Combination of corticosteroids with immunosuppressants (Azathioprine, cyclophosphamide, methotrexate, chlorambucil) especially in patients who do not respond to corticosteroids after 6-8 weeks of treatment. When the clinical response is good, reduce the dose of both types, then use the maintenance dose with corticosteroids alone. In mild cases, Sulfones (dapsone) 100-150 mg/day can be used, usually after 2 weeks. It has been reported that the use of Tetracycline in combination with niacinamide has been effective in some cases. Control itching (usually antihistamine H1). Scratching and ultraviolet rays should be avoided. Some questionable drugs should be avoided.

In addition, the treatment of bullous pemphigoid disease requires a suitable diet and the following issues should be noted:
Take prescribed medicine. Also, tell your doctor about all the medications you take, including over-the-counter medicines. Eat nutritious food. A liquid or light diet can help relieve pain when eating or swallowing. Clean the skin to avoid infection. Check the skin's recovery process. Watch for signs of infection such as redness, discharge, pain, swelling or swelling in the lymph nodes, and fever. Wash clothes, towels, and bedding regularly if blisters ooze, break, crust, or become infected. Call your doctor if you have symptoms of an infection, your skin is getting worse, you have new swelling, or you have new symptoms. Get medical care if you have fever, lethargy, confusion or weakness, blisters spreading all over your body, or ulceration of the oral mucosa causing difficulty in eating, especially in elderly patients.