Burst blisters in an elderly patient

The patient may report an itchy redness of the skin for the previous month before the blisters eventually erupt on the red base. Initially the blisters may burst and form crusts as in this case, so you may be misled in making the correct diagnosis. Bullous pemphigoid is an autoimmune disease and is much more common than pemphigus in elderly patients. It will ultimately resolve but usually requires oral steroids and a steroid sparing agent such as azathioprine to control the blisters and allow the lowest dose of oral steroids possible to be used. Excision of a small blister for histology and immunofluorescence is useful to confirm the diagnosis. For images of these log into www.skinconsult.com.au

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