ABSTRACT
Many inflammatory skin disorders can produce blistering at some stage in their natural history. In the primary blistering diseases, blistering is the major feature of the disease and a direct result of the initial pathological process. Bullous pemphigoid is an uncommon, acute blistering disease occurring mainly in the over-60s. Large, tense, often blood-stained blisters develop over a few days anywhere on the skin surface. Epidermolysis bullosa acquisita shares many similarities to bullous pemphigoid, although it is much more difficult to treat and the blisters tend to affect areas of friction or trauma and the mucosal surfaces more frequently. The blisters themselves should be treated with ‘wet dressings’. Pemphigus causes blistering because of a loosening of desmosomal links between epidermal cells caused by immunological attack. Large doses of systemic steroids are required to control the blistering. Immunosuppressive therapy with azathioprine or methotrexate should be started simultaneou.
