Bullous pemphigoid is an autoimmune skin disease affecting mainly elderly population. It is characterized by intact blisters on trunk and limbs, might be as large as 5cm, which is almost the size of a tennis ball. Sometimes the blisters could be red as blood-filled. Some people might experience itchiness or hives like rash before the blisters (urticarial phase), which makes the diagnosis not straight forward.
A special kind of skin biopsy with immunofluorescence test is required to arrive at the correct diagnosis. Blood tests including specific bullous pemphigoid antibody titre are usually indicated. Oral treatment including antibiotics and sometimes immunosuppressants like steroid, cyclosporine are needed to control bullous pemphigoid with good effect. However, the treatment usually is in terms of months to years, and side effects especially in elderly patients have to be carefully monitored.