CME in Minutes: Education in Dermatology
Aug 20, 2026 · 15 min · 8 segments
Please visit answersincme.com/ZYD860 to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by April W. Armstrong, MD, MPH. In this…
April W. ArmstrongGuest
Today, we're gonna take control of bullous pemphigoid, a blistering autoimmune skin disease that is oftentimes underdiagnosed and undertreated.
When we think of BP, we typically picture tense bullae, but clinically, many patients do not start there.
In practice, the earliest clue is often new intense itch in an older adult, especially when it is persistent, when it disturbs sleep, and when it does not behave like your routine eczema or urticaria.
Now, tense bullae are helpful when present because they suggest a subepidermal blistering process, but absence of bullae does not rule out BP.
Mucosal disease can occur, but when mucosal involvement is prominent, I would actually think more carefully about mucous membrane pemphigoid and other immunobullous diseases.
These patients often have major sleep disruptions, mood effects, wound care needs, as well as caregiver burden, and also a risk of infection from erosions.
When you're thinking about taking the medical history, I would make it rather practical.
I would review their medication list, especially for DPP4 inhibitors or gliptins, diuretics, neuropsychiatric medications, and other medication changes.
Another pearl that I want to share is to ask your patients about their neurologic comorbidities, diabetes, renal disease, and anticoagulation history early because some of these comorbidities may affect your treatment choices later on.
So the takeaway for this is that we want to lower our threshold for biopsy, especially in older adults with new severe pruritus or atypical eczematous or urticarial disease.
Today, we're gonna take control of bullous pemphigoid, a blistering autoimmune skin disease that is oftentimes underdiagnosed and undertreated.
When we think of BP, we typically picture tense bullae, but clinically, many patients do not start there.
In practice, the earliest clue is often new intense itch in an older adult, especially when it is persistent, when it disturbs sleep, and when it does not behave like your routine eczema or urticaria.
Now, tense bullae are helpful when present because they suggest a subepidermal blistering process, but absence of bullae does not rule out BP.
Mucosal disease can occur, but when mucosal involvement is prominent, I would actually think more carefully about mucous membrane pemphigoid and other immunobullous diseases.
These patients often have major sleep disruptions, mood effects, wound care needs, as well as caregiver burden, and also a risk of infection from erosions.
When you're thinking about taking the medical history, I would make it rather practical.
I would review their medication list, especially for DPP4 inhibitors or gliptins, diuretics, neuropsychiatric medications, and other medication changes.
Another pearl that I want to share is to ask your patients about their neurologic comorbidities, diabetes, renal disease, and anticoagulation history early because some of these comorbidities may affect your treatment choices later on.
So the takeaway for this is that we want to lower our threshold for biopsy, especially in older adults with new severe pruritus or atypical eczematous or urticarial disease.
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