Bullous Pemphigoid

Bullous pemphigoid: Overview

Bullous pemphigoid

What is bullous pemphigoid?

This is a rare autoimmune disease that can cause large blisters on the skin. Blisters can develop on other areas like inside the mouth, but this is rare.

Is it contagious? No.

Bullous pemphigoid is a chronic disease, which means it lasts longer than six weeks. For many people, this disease lasts for months or years. As older blisters open and crust over, new blisters can appear.

While bullous pemphigoid is known for causing large blisters, you may notice changes to your skin before the blisters appear for the first time. This disease can begin with itchy skin. For some people, the itch feels intense and makes it hard to sleep.

Bullous pemphigoid on a patient’s arm

This disease causes blisters, which often develop on skin that itches.

Patient with bullous pemphigoid on his arm.

You may also develop a rash before you see the first blisters. This rash often looks like welts or raised patches on the skin. The rash can appear in one or two places on your skin or be widespread. The rash often itches.

Although bullous pemphigoid is a disease that causes blisters, some people only develop itching and a rash. It’s also possible to develop blisters and never see a rash.

If you develop blisters, the blisters tend to come and go. You could have new blisters every day. Other times, the disease calms down, so you may not see blisters for a while.

Treatment can prevent (or reduce) itching, rash, and how many new blisters you get. When this happens, the disease is said to be in remission.

A remission differs from a cure. When a disease goes into remission, the signs and symptoms either disappear or decrease noticeably. A disease in remission can come back.

It can take time for treatment to send bullous pemphigoid into remission. If the disease covers a large area or has been around for years, remission can take a year or longer.

It can also take time to find a treatment that works for you. Some people try a few different treatments before one works.

Although rare, dermatologists are seeing more patients with this disease. It’s believed that this is happening for two reasons:

  1. People are living longer, so they’re more likely to develop this disease, which often begins after 60 years of age.

  2. Some newer medications that treat diabetes, cancer, and other diseases may trigger bullous pemphigoid.

If you have blisters that come and go, itching all over your body, or other signs of bullous pemphigoid, it’s important to see a dermatologist. Left untreated, this disease can lead to a serious infection or other life-threatening medical condition.

You’ll find the symptoms often caused by bullous pemphigoid, along with more pictures of bullous pemphigoid, at: Bullous pemphigoid: Signs and symptoms.


Image
Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References
Bernard P, Borradori L. “Pemphigoid group.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018: 510-9.

Brick KE, Weaver CH, et al. “Incidence of bullous pemphigoid and mortality of patients with bullous pemphigoid in Olmsted County, Minnesota, 1960 through 2009.” J Am Acad Dermatol. 2014;71(1):92-9.

Culton DA, Zhi L, Diaz LA. “Bullous pemphigoid.” In: Kang S, et al. Fitzpatrick’s Dermatology. (ninth edition) McGraw Hill Education, United States of America, 2019:944-55.

Grantham HJ, Stocken DD, et al. “Doxycycline: a first-line treatment for bullous pemphigoid?” Lancet. 2017 Apr 22;389(10079):1586-8.

Han A. “A practical approach to treating autoimmune bullous disorders with systemic medications.” J Clin Aesthet Dermatol. 2009 May;2(5):19-28.

Heymann WR. “Targeted anti-complement therapy may prove to be a complementary treatment for bullous pemphigoid.” Dermatol World Insights & Inquires. 2020;2(40).

Yosipovitch G and Kwatra SG. “Itch associated with autoimmune disorders.” In: Living with itch: A patient’s guide. The Johns Hopkins University Press. United States of America, 2013: 63-5.


Written by:
Paula Ludmann, MS

Reviewed by:
Arturo R. Dominguez MD, FAAD
Ivy Lee, MD, FAAD
Shari Lipner, MD, PhD, FAAD

Last updated: 9/21/21


All content solely developed by the American Academy of Dermatology

Bullous pemphigoid: Signs and symptoms

Where does bullous pemphigoid develop on the body?

Bullous pemphigoid is a disease that causes blisters, which can develop anywhere on the skin.

Most people develop blisters on one or more of the following areas:

  • Arms

  • Armpits

  • Legs

  • Abdomen

  • Groin

  • Mouth

The blisters may appear on a few or many areas of the skin. When the blisters develop on many areas, the medical term for this is “widespread.” Widespread blisters appear in many areas like the arms, back, chest, and legs.

One type of bullous pemphigoid develops only on the:

  • Hands (palms) and feet (soles)

Occasionally, some people living with bullous pemphigoid develop blisters:

  • Inside their mouth or throat

What are the signs and symptoms of bullous pemphigoid?

Often beginning after 60 years of age, this disease usually causes a cycle of blisters. As the old blisters clear, new blisters often form.

While bullous pemphigoid is a blistering disease, research shows that about 20% of people who develop this disease never get blisters. Instead, they can have itching, a rash, or both.

The following pictures show what bullous pemphigoid can look like.

Itch

Before the blisters appear for the first time, your skin may itch. Some people have mildly itchy skin. For others, the itch can be intense. The itch can begin weeks (or months) before blisters appear. Sometimes, a few areas itch. Other times, the entire body itches.

Woman scratching arm

Rash may appear, which can last for days or weeks

Along with itchy skin, some people develop a rash that can look like hives (or large welts), as shown here. The rash can also look like a case of itchy eczema.

Rash due to bullous pemphigoid

Blisters appear and can last for days

The blisters can appear on skin with (or without) a rash. The patients shown here developed blisters on their neck. If you have a darker skin tone, the blisters may be dusky pink, brown, or black. In lighter skin tones, the blisters often look yellow, pink, or red.

Bullous pemphigoid blisters on white skin and on black skin

Solid-feeling blisters

Some blisters are large, measuring two inches in diameter. Others will be smaller. Regardless of size, the blisters feel like they’re stretched tight, and the blisters don’t rupture easily when touched.

Large blister of bullous pemphigoid

Blisters rupture on their own

In time, the blisters collapse and crust over. When a blister clears, the skin tends to feel raw and tender. Crusts often form where the blisters had been.

What skin looks like when bullous pemphigoid blisters rupture.

Spots can appear as the blisters clear

As the blisters go away, you may see spots of discolored skin (or tiny, raised, white bumps) where you had the blisters. These spots and bumps aren’t scars. These spots, which may be lighter or darker than your natural skin tone, will fade with time, and so will the tiny, raised bumps.

Spots on skin after bullous pemphigoid blisters clear.

New blisters often continue to appear

Bullous pemphigoid is a chronic disease, which means it can last a long time. For some people, new blisters will continue to appear for years or a lifetime. It’s also possible that the blisters will go away on their own in a few months. Treatment can help reduce flare-ups and ease the itch.

Severe bullous pemphigoid

While bullous pemphigoid is a rare disease, more people are developing it. You can see if you have a higher risk of developing this disease at: Bullous pemphigoid: Causes.


Images
Image 1: Getty Images

Images 2,3,4,6,7,8: Used with permission of the Journal of the American Academy of Dermatology and JAAD Case Reports:

  • J Am Acad Dermatol 2001;45:246-9.

  • JAAD Case Reports 2015;1:359-60.

  • JAAD Case Reports 2020;6:400-2.

  • JAAD Case Reports 2016;2:442-4.

  • J Am Acad Dermatol 2009;60:1042-4.

  • J Am Acad Dermatol 2011;65;1061-3.

Image 5: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References
Bernard P, Borradori L. “Pemphigoid group.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018: 510-9.

Cohen PR. “Dyshidrosiform bullous pemphigoid.” Medicina (Kaunas). 2021 Apr 20;57(4):398.

Culton DA, Zhi L, Diaz LA. “Bullous pemphigoid.” In: Kang S, et al. Fitzpatrick’s Dermatology. (ninth edition) McGraw Hill Education, United States of America, 2019:944-55.

Qiu C, Shevchenko A, et al. “Bullous pemphigoid secondary to pembrolizumab mimicking toxic epidermal necrolysis.” JAAD Case Reports 2020;6:400-2.

Tull TJ, Benton E. “Immunobullous disease.” Clin Med (Lond). 2021;21(3):162-5.


Written by:
Paula Ludmann, MS

Reviewed by:
Arturo R. Dominguez MD, FAAD
Ivy Lee, MD, FAAD
Shari Lipner, MD, PhD, FAAD

Last updated: 9/21/21


All content solely developed by the American Academy of Dermatology

Bullous pemphigoid: Causes

What causes bullous pemphigoid?

Bullous pemphigoid is an autoimmune disease. This type of disease develops when your immune system malfunctions, causing your body to attack a part of itself.

When you have bullous pemphigoid, your body attacks fibers that connect the top layer of skin (epidermis) to the deeper layer (dermis).

This attack produces inflammation, which is what causes the skin to itch and the blisters to develop. Why the body starts attacking these fibers isn’t entirely clear.

Who has a higher risk of developing bullous pemphigoid?

Scientists have learned that some people have a higher risk of developing bullous pemphigoid.

Your risk increases if you:

  • Are over 60 years of age

  • Had a stroke

  • Have dementia, epilepsy, multiple sclerosis, or Parkinson’s disease

It’s unlikely that your sex or race increase your risk. Bullous pemphigoid occurs equally in men and women. This disease also occurs in people of all races.

Bullous pemphigus usually develops after 60 years of age

Most people are in their 70s when they get this disease.

Couple looking online for information.

Bullous pemphigoid may have triggers

A trigger is something that either:

  • Brings about a disease in someone whose genetic makeup increases the likelihood of developing that disease

  • Causes symptoms in a person who already has a disease

There have been reports that the following can trigger bullous pemphigoid:

Certain prescription medications: While some medications have been reported to trigger this disease, it’s important to keep in mind that bullous pemphigoid is a rare disease. Many people who take one of the following medications never get bullous pemphigoid:

  • Pembrolizumab, nivolumab: Given to treat melanoma and other cancers that have spread

  • Saxagliptin, sitagliptin, vildagliptin: Diabetes medications

  • Penicillin: An antibiotic

  • Sulfasalazine: An anti-inflammatory

  • Etanercept: A biologic

  • Penicillamine: Given to treat Wilson’s disease or severe rheumatoid arthritis

Medical treatments: A few people have developed bullous pemphigoid after undergoing:

  • Radiation therapy to treat cancer

  • Ultraviolet light therapy

Surgery: There have also been reports of people developing bullous pemphigoid after having a:

  • Colostomy

  • Urostomy

  • Skin graft

If a medical treatment has caused blisters, see a board-certified dermatologist. Treating bullous pemphigoid can prevent (or reduce) the new blisters that appear, reducing your risk of developing a serious infection.

To find out how dermatologists diagnose and treat this rare disease, go to: Bullous pemphigoid: Treatment.


Image
Getty Images

References
Bernard P, Borradori L. “Pemphigoid group.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018: 510-9.

Culton DA, Zhi L, Diaz LA. “Bullous pemphigoid.” In: Kang S, et al. Fitzpatrick’s Dermatology. (ninth edition) McGraw Hill Education, United States of America, 2019:944-55.

Heymann WR, “Untangling the neurologic comorbidities of bullous pemphigoid.” Dermatol World Insights & Inquiries. Last updated June 6, 2017. Last accessed July 9, 2021.

Tull TJ, Benton E. “Immunobullous disease.” Clin Med (Lond). 2021;21(3):162-5.


Written by:
Paula Ludmann, MS

Reviewed by:
Arturo R. Dominguez MD, FAAD
Ivy Lee, MD, FAAD
Shari Lipner, MD, PhD, FAAD

Last updated: 9/21/21


All content solely developed by the American Academy of Dermatology

Bullous pemphigoid: Diagnosis and treatment

How do dermatologists diagnose bullous pemphigoid?

Bullous pemphigoid is a disease that can cause widespread blisters, itching, and rash on your skin, and sometimes even inside your mouth and other areas.

If you are worried that you have bullous pemphigoid, seeing a board-certified dermatologist can help you get an accurate diagnosis and treatment.

Different types of diseases can cause blisters, and specialized testing may be necessary to find out what type of blistering disease you have. This specialized testing is usually performed by dermatologists.

To find out if you have bullous pemphigoid, your dermatologist will:

  • Ask questions

  • Examine your blisters and rashes

  • Perform one or more skin biopsies (can be done during an office visit)

  • Order blood tests, as needed

During your first appointment, your dermatologist will look for signs of infection as well as examine any blisters and rashes. If you have a skin infection or blisters cover a large area of your body, your dermatologist may admit you to a hospital. Having widespread blisters can lead to a type of infection called sepsis, which is a life-threatening condition.

If you have blisters that are leaking fluid and opening up, get immediate (within 24 hours) medical care

Treatment can prevent a serious — and sometimes life-threatening — infection.

Dermatologist caring for patient.

Patients with widespread blisters may be admitted to a hospital’s burn unit. A burn unit provides the right environment, temperature, and humidity, along with the expertise needed to care for widespread blisters.

You may be admitted to the hospital before you are diagnosed with bullous pemphigoid. It takes time to get the results from medical tests.

If the medical tests confirm that you have bullous pemphigoid, your dermatologist will create a personalized treatment plan.

Have you had cancer, surgery, or radiation therapy?

Be sure to tell your dermatologist, as some treatments, surgeries, and medications can trigger bullous pemphigoid.

Senior woman talks with dermatologist

Will bullous pemphigoid go away without treatment?

This disease tends to come and go. You will likely have times when you continue to get new blisters and weeks when you have few — if any — blisters. Sometimes, this disease goes away without treatment and the person never develops blisters again.

Medical records show that before treatment was available for bullous pemphigoid, about 20% of patients went into remission after 15 months. This means that the itch, rash, and blisters went away after 15 months without treatment.

Remission differs from a cure. When a patient is in remission, the disease can come back. If the disease comes back, the patient is said to have a relapse.

If you have bullous pemphigoid, treatment can reduce the amount of time that it takes for bullous pemphigoid to go into remission.

For a few patients, remission begins 9 weeks after starting treatment. About 50% of patients go into remission about two years after treatment starts.

To stay in remission, you may need to continue treating bullous pemphigoid. Some patients continue to treat it for months to years to keep the disease under control.

How do dermatologists treat bullous pemphigoid?

Your dermatologist will tailor your treatment plan to your needs. The goals of treatment are to:

  • Stop (or reduce) new blisters

  • Heal existing blisters and sores

  • Treat an infection if it has developed

  • Relieve any itch and pain

A personalized treatment plan usually includes medication and wound care.

Treatment can help heal your skin so that bullous pemphigoid goes into remission

Treatment can also help relieve the itch and pain.

Smiling dermatologist with female patient

Medication: Your dermatologist may prescribe creams and ointments called corticosteroids. These help to heal your skin, prevent new blisters from appearing, and relieve the itch. If you have severe bullous pemphigoid, your dermatologist may prescribe corticosteroid pills.

Corticosteroids are powerful medications that act quickly to get your disease under control. Like other medications, corticosteroids can have side effects. Possible serious side effects include stomach ulcers or bleeding, bone loss that can lead to weak and fragile bones, eye problems, and diabetes.

To reduce your risk of developing side effects, your dermatologist may prescribe more than one medication. Adding a second or third medication may allow you to take a lower dosage of corticosteroids, which can reduce your risk of developing side effects.

If you do develop side effects, your dermatologist may team up with your primary care doctor to treat you.

Tell your dermatologist about all medications, vitamins, and supplements that you take — or plan to take

Some can interact with the medication in your treatment plan.

Dermatologist explains treatment plan to patient

Other medications are also prescribed to treat bullous pemphigoid.

Tetracycline, doxycycline, and dapsone are antibiotics, which can reduce the inflammation inside your body. For some patients, applying a corticosteroid cream or ointment and taking an antibiotic provides effective treatment.

Some patients take a medication called an immunosuppressant. This medication helps to calm the immune system. If you need an immunosuppressant, your dermatologist may prescribe mycophenolate mofetil, methotrexate, azathioprine, or another medication that works on the immune system.

Before taking an immunosuppressant, make sure your vaccinations are up to date. Taking this type of medication can increase your risk of developing certain infections.

Dupilumab, omalizumab, or rituximab may be an option when other treatments fail to work. Instead of suppressing your immune system, these medications change the way your immune system reacts.

Wound care: Open blisters and raw skin can become infected. Wound care can prevent infection, relieve pain, and speed up healing.

Your dermatologist will create a wound care plan that meets your individual needs. Most wound care involves daily cleaning of the wounds, applying medication, and bandaging. When necessary, your dermatologist may refer you to a wound care specialist.

Treatment can take time

The amount of time you need to treat bullous pemphigoid will depend on how severe the disease is and your response to treatment.

Most patients follow a treatment plan for six months to five years before the disease goes into long-term remission. Once the disease is in long-term remission, many patients can stop treatment. However, some patients need to continue treatment.

Follow-up medical appointments are essential

Treating bullous pemphigoid can be complicated. Your dermatologist may coordinate with your primary care doctor and other doctors as needed. Keeping all of your medical appointments will help:

  • Determine whether the treatment works for you or needs to be modified.

  • Find side effects early.

  • See if an infection, which can be serious, has developed.

  • Make sure you know what to do, so you can follow your treatment plan.

Following a self-care plan for bullous pemphigoid can improve the results you get from treatment and how well you feel. You’ll find the self-care that dermatologists recommend at: Bullous pemphigoid: Self-care.


Images
Getty Images

References
Abdat R, Waldman RA, et al. “Dupilumab as a novel therapy for bullous pemphigoid: A multicenter case series.” J Am Acad Dermatol. 2020;83(1):46-52.

Bernard P, Borradori L. “Pemphigoid group.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018: 510-9.

Chan, LS. “Bullous pemphigoid.” In: Medscape (Elston DM., Ed.) Last updated 10/14/2020. Last accessed 7/9/2021.

Culton DA, Zhi L, Diaz LA. “Bullous pemphigoid.” In: Kang S, et al. Fitzpatrick’s Dermatology. (ninth edition) McGraw Hill Education, United States of America, 2019:944-55.

Mutasim DF. “Management of autoimmune bullous diseases: pharmacology and therapeutics.” J Am Acad Dermatol. 2004;51(6):859-77.

Grantham HJ, Stocken DD, et. al. “Doxycycline: a first-line treatment for bullous pemphigoid?” Lancet. 2017 Apr 22;389(10079):1586-8.

Han A. “A practical approach to treating autoimmune bullous disorders with systemic medications.” J Clin Aesthet Dermatol. 2009 May;2(5):19-28.

Nadelmann E, Czernik A. “Wound care in immunobullous disease.” IntechOpen. Published 5/9/2018. 10.5772/intechopen.71937. Last accessed 7/9/2021.

Yosipovitch G and Kwatra SG. “Itch associated with autoimmune disorders.” In: Living with itch: A patient’s guide. The Johns Hopkins University Press. United States of America, 2013: 63-5.


Written by:
Paula Ludmann, MS

Reviewed by:
Arturo R. Dominguez MD, FAAD
Ivy Lee, MD, FAAD
Shari Lipner, MD, PhD, FAAD

Last updated: 9/21/21


All content solely developed by the American Academy of Dermatology

Bullous pemphigoid: Self-care

If you think a medication may be causing a reaction, contact your dermatologist right away

Side effects can happen soon after you start taking a medication or weeks to months later.

Patient using telemedicine to talk with dermatologist

Taking good care of yourself at home may help blisters caused by bullous pemphigoid to clear more quickly. Good care can also prevent a serious infection. Here’s what dermatologists recommend for their patients who have bullous pemphigoid.

Protect your skin from irritation and injury

Bullous pemphigoid makes skin fragile. To help you get the best results from treatment, dermatologists recommend that you:

  • Try not to scratch. When you scratch, you can injure your skin.

  • Relieve an area of itchy skin with a cool compress. To make a cool compress, run a clean washcloth under cold water and wring out the washcloth so that water doesn’t drip. Then apply your cool compress to the itchy skin and leave it there for 10 to 20 minutes.

  • Protect your skin from the sun. If sunlight hits skin with blisters, sores, or rashes, this can be painful. If you need to be outdoors in the sun, protect your skin by seeking shade, wearing sun-protective clothing, and applying sunscreen that offers broad-spectrum protection, water-resistance, and an SPF of 30 or higher. Apply your sunscreen to all skin not covered by clothing.

  • Wear loose-fitting cotton clothing. This will reduce rubbing, which could irritate your skin.

  • Limit your activities until the blisters are under control. This means no contact sports, swimming, or heavy household chores. If you have blisters on your feet, limit walking.

  • Only pop or drain a blister if your dermatologist tells you to do so. When your dermatologist recommends draining a blister, you will receive instructions on how to do this safely. Without these safety precautions, you could cause a serious, and possibly life-threatening, infection.

Wash your hands

If you have germs on your hands and then touch a blister or skin where a blister just ruptured, you can develop an infection. Washing with soap and water helps to remove germs from your hands. The Centers for Disease Control and Prevention (CDC) provides information about when and how to wash your hands.

Look for signs of infection every day

Blisters and open skin can easily become infected. It’s important to watch for these warning signs of infection on your skin:

  • Warmth and swelling

  • Pain or tenderness

  • Pus

  • Red (light skin) or brown (dark skin) streaks

  • Yellow or golden crusts

  • Draining fluid

  • Unpleasant odor (new or worsening)

If you have an infection, you may also feel very hot or cold, or have a fever.

Take your temperature if you think you might have an infection. If your temperature is higher than 100.4° F (38.0°C), call your dermatologist or primary care physician. Tell the person who answers the phone that you have bullous pemphigoid and a fever.

If your skin looks infected, immediately call your dermatologist

Treating an infection early can prevent it from spreading and causing a life-threatening illness.

Follow your treatment plan

It can take several weeks for blisters to start drying up and new blisters to stop forming. When you don’t see results right away, you may be tempted to stop following your treatment plan. Continue with your treatment plan, making sure that you:

  • Take (or apply) all medication and vitamin supplements, as directed.

  • Care for your blisters and open sores (wound care), as directed.

  • Report possible side effects to your dermatologist right away.

  • Call your dermatologist right away if you have trouble following your treatment plan.

For more information about treatment, go to Bullous pemphigoid: Diagnosis and treatment.

Care for mouth sores

Some people who have bullous pemphigoid develop blisters in their mouth. When this happens, dermatologists recommend the following:

  • Eat only soft foods. This list of foods includes yogurt, mashed potatoes, and oatmeal. Food can be warm, but not hot.

  • Stop consuming foods and beverages that irritate your mouth. Anything that is spicy, acidic, crunchy, or hard might irritate your mouth and feel painful. Foods that can do this include raw vegetables like celery and carrots, crackers, potato chips, and raw fruits. Acidic beverages like alcohol, black coffee, orange juice, or soda pop can also irritate your mouth.

  • Use a soft toothbrush. This helps reduce irritation and possible pain.

  • Rinse with an alcohol-free antiseptic mouthwash. Dermatologists recommend rinsing with this mouthwash, as it helps to prevent infection and can help you feel better. Just make sure the mouthwash is alcohol-free, as alcohol can irritate the blisters.

Keep all follow-up medical appointments

You will need to see your dermatologist for follow-up care. During these visits, your dermatologist will:

  • Assess how well the treatment is working.

  • Check for possible side effects.

  • Look for signs of infection and pressure sores.

  • Make changes to your treatment plan if needed.

Your dermatologist will also coordinate with your primary care doctor. You may also need to see your dentist and other doctors. Some patients see:

  • A doctor who specializes in diseases of the head and neck (otolaryngologist)

  • An eye doctor (ophthalmologist)

  • Another specialist

It’s important that you keep all of these appointments, too. During your primary care visits, you’ll have your:

  • Blood pressure and blood sugar checked

  • Blood drawn to look for possible side effects from treatment

  • Checkup to look for signs of infection

Get support

Both people who have bullous pemphigoid and their caregivers can find it difficult to cope. If that describes you, help is available.

The International Pemphigus and Pemphigoid Foundation offers Peer Health Coaches (PHC). These coaches are people who have pemphigus or pemphigoid. They help more than 1,200 patients and caregivers each year.

The Foundation also offers support groups.

You can find out more about coaches, support groups, and this disease at the International Pemphigus and Pemphigoid Foundation.


Image
Getty Images

References
Chan, LS. “Bullous pemphigoid.” In: Medscape (Elston DM., Ed.) Last updated 10/14/2020. Last accessed 7/9/2021.

Nadelmann E, Czernik A. “Wound Care in Immunobullous Disease.” IntechOpen. Published 5/9/2018. 10.5772/intechopen.71937.


Written by:
Paula Ludmann, MS

Reviewed by:
Arturo R. Dominguez MD, FAAD
Janet A. Fairley, MD, FAAD
Ivy Lee, MD, FAAD
Shari Lipner, MD, PhD, FAAD

Last updated: 9/21/21


All content solely developed by the American Academy of Dermatology




All content solely developed by the American Academy of Dermatology.

Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

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