From the Guidelines
Bullous pemphigoid affecting the hands and feet should be treated with superpotent topical corticosteroids as the first line of treatment, according to the European Dermatology Forum consensus 1.
Presentation and Diagnosis
Bullous pemphigoid affecting the hands and feet typically presents as tense, fluid-filled blisters on reddened skin. These blisters can range from small vesicles to large bullae and may be accompanied by intense itching. In the hands, the blisters often appear on the palms and between fingers, while on the feet they commonly develop on the soles and between toes. The condition is an autoimmune disorder where antibodies target proteins in the basement membrane zone of the skin, causing separation between the epidermis and dermis. Diagnosis requires clinical examination, skin biopsy, and immunofluorescence studies.
Treatment Approach
Treatment typically involves:
- Topical corticosteroids like clobetasol propionate 0.05% applied twice daily for mild cases
- More extensive disease requires oral corticosteroids (prednisone 0.5-1 mg/kg/day), often combined with steroid-sparing agents such as azathioprine (1-2.5 mg/kg/day), mycophenolate mofetil (1-2 g/day), or doxycycline (100 mg twice daily) 1
- Proper wound care for ruptured blisters is essential to prevent secondary infections, which may include leaving blisters intact if possible, piercing large blisters with a sterile needle, or using antiseptics such as potassium permanganate for extensive areas of erosion 1
- Patients should avoid trauma to affected areas and may need pain management for discomfort
Management and Follow-Up
The condition typically requires months of treatment with gradual tapering of medications under medical supervision. A maintenance treatment should be continued for 8 months, with a total treatment duration of 12 months, as recommended by the European Dermatology Forum consensus 1.
From the Research
Bullous Pemphigoid Overview
- Bullous pemphigoid (BP) is the most frequent auto-immune blistering skin disease 2, 3.
- It can affect various parts of the body, including the hands and feet.
Treatment of Bullous Pemphigoid
- Topical corticosteroids, such as clobetasol propionate, have been shown to be effective in treating BP, with fewer systemic side effects compared to oral corticosteroids 2, 4, 3, 5.
- A study found that whole body application of clobetasol propionate cream can be effective and safe in the induction phase of treatment in mild and severe BP 4.
- Another study demonstrated that high doses of very potent topical corticosteroids increased initial disease control and 1-year survival of patients with extensive BP, as compared with oral prednisone 6.
Images of Bullous Pemphigoid
- Unfortunately, there are no images provided in the given studies to illustrate bullous pemphigoid on the hands and feet.
- However, the studies suggest that topical corticosteroids can be effective in treating BP, regardless of the location of the lesions 2, 4, 3, 5, 6.