Bullous Pemphigoid

Key points

• Bullous pemphigoid: autoimmune (anti-BP180/BP230 hemidesmosomal) subepidermal blistering — TENSE bullae on flexures/lower abdomen, elderly patients.
• Nikolsky's sign NEGATIVE; oral involvement less common than pemphigus.
• Immunofluorescence: linear IgG/C3 along basement membrane.
• Management: potent topical steroids (may suffice) or oral steroids; tetracyclines/nicotinamide alternatives.
• Drug triggers: furosemide, DPP-4 inhibitors, penicillamine.

Decision points in this pathway

• Localised/mild?

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