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Bullous Pemphigoid

Bullous Pemphigoid is a very rare skin condition that gives rise to large, fluid-filled blisters. These blisters develop in the area of the skin that can flex, e.g. the armpits, lower abdomen and upper thighs. It can appear in a few areas in the body or can be widespread. One third of the patients develop blisters in their mouth, throat and esophagus apart from the skin. The condition occurs when the body's immune system attacks a thin layer of the tissue below the outer layer of the skin.


Bullous Pemphigoid is a rare occurrence in young adults and children. This condition is common in older people within the age group of 50 to 80. Bullous Pemphigoid is also slightly more common in women than men. Bullous Pemphigoid can get life threatening for older people with poor health. The condition settles down on its own within 5 years. In a few extreme cases, the condition lasts longer. The condition is not infectious and does not spread. Bullous Pemphigoid is commonly seen in the areas of the arms, mouth, groin, legs and abdomen. The exact cause for Bullous Pemphigoid is not clearly known. It is an autoimmune disease.


  • Blisters occur due to a problem in the body's immune system.

  • The body produces an antibody against the membrane between the epidermis (top layer of the skin) and the dermis (next layer of the skin) thus leading to the formation of blisters.

  • These blisters are a collection of fluid between the two layers of the skin. Certain medications, light and radiation may also cause the condition.

If the blisters are concentrated around the mucous membranes of your eyes and mouth, then it is called mucous membrane pemphigoid. Blisters on the eyes can lead to scarring.

  • Initial symptoms include small patches of itchy skin, pink rashes that resemble eczema.

  • Blisters develop within a week from the appearance of rashes.

  • Blisters are dome shaped and do not break when touched.

  • The fluid in the blister is usually clear or may contain some blood.

  • Blisters commonly appear in the lower abdomen, groin, arms and upper thigh.

  • Blisters appear in the crease/fold of the skin.

  • The number of of blisters may vary, a few areas of the body may get affected or the entire body may get affected.

  • The affected area may get itchy.

  • A few people may develop hives or eczema instead of blisters.

Skin biopsy is done. A blood test may help detect pemphigoid antibodies. This can be detected from urine sample of the person or from the fluid collected in the blister. The common treatment involved in treating Bullous Pemphigoid is aimed at relieving the person from itching and to heal the affected skin. Treatment may include corticosteroids, drugs to fight inflammation and drugs to suppress the immune system.


Second Degree Burns

When the epidermis and part of the dermis of the skin are involved in any burn injury, it is known as a second-degree burn. Depending on the level of nerve involvement, the severity of the pain varies in second-degree burns. In the case of second-degree burns, in addition to superficial blistering, there is accumulation of clear liquid in the area. Involving superficial or papillary dermis, second-degree burns sometimes involve the reticular or deep layer of the dermis.


When the skin experiences any burn or surface damage, the surrounding layer of the skin expands resulting in a blister. The Plasma or serum is released as the result of the damaged Keratinocytes - outermost layer of the skin. The released plasma /serum helps to prevent further damage and also to help in the healing process. This is the reason why blisters should not be punctured as it would invite infection to the affected skin. The serous fluid will be reabsorbed by the skin usually after 24 hours if there is no infection.


According to the severity of these burns, they are further classified as deep or superficial. When only the outermost part of the dermis is involved, it is called superficial. Extreme pain and hypersensitivity to touch are characteristics of superficial burns. Appearing moist and red or mottled pink in color, the skin at the area of the burn blanches on pressure. Usually blisters appear after some time. Normally, this kind of superficial second - degree or partial thickness burns heal by themselves.

Blood Blister : This ensues when a part of the skin is pinched or crushed with force. The capillaries affected by the force rupture leaking blood into the skin.

Tissue destruction to the deeper layers of the dermis is involved in deep second - degree and deep partial thickness burns. In contrast to the superficial type, these deep second -degree burns are usually dry and whitish in appearance, but they may appear like superficial burns. Normally pain is associated with this type of burns, though the skin does not blanch. It may take three to four weeks for the burn to heal. Thick or hypertrophic scars may remain even after the injury heals.

Causes of a second-degree burn include scald injuries, flames and a brief contact of the skin with a hot object. Sometimes deep sunburn, contact with hot liquids or chemicals and burning gasoline or kerosene also may cause second-degree burns. With second degree burns, the skin color turns to deep red and you will notice blisters. The burnt area appears shiny and moist. Second-degree burns that are only superficial normally heal in about three weeks. Care should be taken to keep the wound clean and protected. For effective treatment of second degree burns, the following conditions are considered:

  • The medical history, overall health and the age of the patient
  • To what extent the burn has damaged the skin
  • Site of the burn
  • Incident that caused the burn

Person affected by burns of this type may go into shock, since they lose lots of fluid from the burned site, if the injury involves more than 10% of skin. If a second-degree burn is greater than 2 or 3 inches in diameter, only a medical professional should treat it. It is safe to treat a burn like this at home only when it is a smaller. According to the severity of the burn, treatment may vary from antibiotic ointments to systemic antibiotics. Every day cleaning of the wound is necessary to remove dead skin. Depending on the severity of the burn, the dressing should be changed at least once or twice a day. It may be painful for the patient when the dressing is changed. A pain reliever or analgesic will help to reduce the pain. Care should be taken not to burst any blisters that have formed.


First Aid for second-degree burns

  • Before the area begins to swell, tight clothing and jewelry should be removed.
  • Cold-water compresses like a wet towel can be applied or flushing the burn with cool running water may also help to lessen the pain. Using ice or ice water can do more harm to the burned area and should be avoided.
  • Do not try to burst the blisters. Breaking blisters will expose the skin which will lead to infection.
  • Covering the burn with a sterile, non-fluffy and dry bandage can be done, but tapes should not be used on top of it.
  • Ointments, grease, petroleum jelly, butter or any home remedies are better avoided.
  • By keeping the burned arms or legs raised, you can reduce swelling.
  • Getting medical help is the best for second-degree burns greater than 2 to 3 inches in diameter or for those on hands, buttocks, penis or vaginal region.

When there are open blisters following second-degree burns:

  • If the clothing is stuck to the burn, better not remove them.
  • Running water over the burn or using water on the bandage will increase the risk of shock and so do not do it.
  • You can cover the burn with a clean, dry, non-fluffy bandage like gauze pad, but do not use tapes on the bandage.
    Get the help of a doctor if the burn is very extensive and more than 2 to 3 inches in diameter.


Cold Sores

Cold sores or fever blisters refer to facial lesions found on the area around the mouth. Cold sores usually appear on your lips. Occasionally, cold sores can be noticed on the nostrils, chin or fingers. Cold sores are painful and the swelling and redness last nearly for about 10 days. Fever sores are a reaction to the latent herpes simplex virus that is already present in the body. A person suffering from fever blisters is likely to suffer fever and headache and pain while swallowing. The cold sores may also affect the person's ability to eat. These sores later develop a yellow crust that is sloughed off to reveal new skin. Cold sores are contagious and this virus can be passed on from sharing towels or eating utensils. Prolonged exposure to sunlight may aggravate the condition of fever blisters or even bring on a recurrence. Cold sores are usually treated with anti-viral creams and cold compress. Aspirin or Ibuprufen may be taken to reduce the pain. When high fever or eye irritation is noticed, it is necessary to contact a doctor.

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Collection of Pages - Last revised Date: December 11, 2017