eMedicine Specialties > Dermatology > Bullous Diseases

Bullous Pemphigoid: Follow-up

Author: Lawrence Chan, MD, Department Head and Director of Skin Immunology Research, Professor, Departments of Dermatology and Microbiology/Immunology, University of Illinois College of Medicine
Contributor Information and Disclosures

Updated: Oct 14, 2008

Follow-up

Complications

  • Secondary infection may occur because of the presence of multiple erosions and immunosuppressants used to control the disease. These infections may be either systemic or localized to the skin. Cutaneous infection increases the risk of scarring and delays wound healing.
  • Malignancies due to immunosuppressants have been reported. Case-control series in patients with BP have failed to detect an increased incidence of malignancy in patients with BP when compared with age- and sex-matched controls
  • Bone marrow suppression may occur in patients receiving immunosuppressants.
  • Growth retardation may occur in children receiving systemic corticosteroids and immunosuppressants.
  • Adrenal insufficiency may occur following prolonged use of glucocorticoids.
  • Osteoporosis and bone fractures may result following the use of systemic corticosteroids.

Prognosis

  • Most patients affected with BP require therapy for 6-60 months, after which many patients experience long-term remission of the disease. However, some patients have long-standing disease requiring treatment for years.
  • Most mortality associated with BP occurs secondary to the effects of the medications.
  • The population at risk for BP is at an increased risk for comorbid conditions, such as hypertension, diabetes mellitus, and heart diseases, which treatment may exacerbate.

Patient Education

  • Patients should avoid trauma to the skin. Patients' skin is fragile from the disease, as well as from the use of topical and systemic steroids.
  • Patients should be educated about their disease and treatments, so that they can report adverse effects to their physicians.

Miscellaneous

Medicolegal Pitfalls

  • Appropriate testing, both routine histologic analysis and immunofluorescence testing, should be performed to confirm the correct diagnosis.
  • Patients on systemic therapy must be appropriately monitored for adverse effects, toxicity, and response to therapy.
  • The Medscape Medical Malpractice and Legal Issues Resource Center may be of interest.

Special Concerns

  • Elderly patients with BP who have other significant health problems, such as diabetes mellitus, hypertension, or heart disease, may require treatment with a more conservative approach, using topical corticosteroids (clobetasol), tetracyclines, and/or low doses of systemic corticosteroids (prednisone 10-20 mg/d). In all patients, the goal of treatment is to achieve disease control with minimal symptoms and adverse effects from treatment.
 


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References
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References

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Further Reading

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Contributor Information and Disclosures

Author

Lawrence Chan, MD, Department Head and Director of Skin Immunology Research, Professor, Departments of Dermatology and Microbiology/Immunology, University of Illinois College of Medicine
Lawrence Chan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Association of Professors of Dermatology, Chicago Dermatological Society, Dermatology Foundation, Illinois State Medical Society, Microcirculatory Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Russell Hall, MD, Chief, Professor, Department of Internal Medicine, Division of Dermatology, Duke University
Russell Hall, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, American Society for Clinical Investigation, and Society for Investigative Dermatology
Disclosure: Genetech Grant/research funds Principle Investigator; Centecor  Grant/research funds Principle Investigator

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Julia R Nunley, MD, Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center
Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society
Disclosure: Johnson and Johnson stock holder dividends; Amgen stock holder dividends; Forest Lab, Inc stock holder dividends; Galaxo Smith Klein stock holder dividends; Covidien stock holder dividends; Novartis Grant/research funds Consulting; Biolex  sub-investigator

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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