Marvin Lester, BA, MD, FRCPC, The Fitness Institute, Mississauga, ON.

Bullous Pemphigoid (BP) is essentially a disease of the elderly with the average age of onset usually in the sixties to seventies. However, this is not a hard and fast rule and it can occur in other ages, including children, although rarely.

BP is thought to be an autoimmune reaction, with circulating basement membrane zone (BMZ) and antibodies of the IgG class present in the majority of cases.

BP has occasionally been reported to be associated with other diseases including Ulcerative Colitis, Dermatomyositis, Diabetes Mellitus, Rheumatoid Arthritis and multiple autoimmune diseases involving organs other than the skin. Drugs have also been reported as possible causes for this condition and include medications such as Furosemide, Enalapril, Captopril, Penicillin and Sulfasalazine.

Clinical Features
The disease is characterized by large, tense, very firm, fluid-filled bullae as opposed to the more flaccid lesions that are seen in bullous diseases such as Pemphigus Vulgaris. In Pemphigus Vulgaris these may be widespread over the skin surface or may be localized to one part of the body including the groin, axillae and flexural surfaces of the forearms. Oral involvement has been reported and varies anywhere from 10-40%; usually an average of about 20% is quoted. Involvement of other mucosal surface such as the throat, nose, vulva, urethra and eye are not common.