Overview
Clinical Orientation
An older adult with weeks of severe itch followed by firm, fluid filled blisters has a pattern that should make bullous pemphigoid a leading consideration.
An older adult with weeks of severe itch followed by firm, fluid-filled blisters has a pattern that should make bullous pemphigoid a leading consideration. The blisters may arise on normal skin or on red, hive-like plaques, and they usually remain tense because the separation occurs beneath the epidermis. The immediate nursing priorities are to determine how widely the skin is involved, protect the blister roof, assess hydration and infection risk, and look for systemic deterioration. Diagnosis is confirmed with appropriately sited biopsy and direct immunofluorescence; treatment then balances rapid disease control against the considerable risks of corticosteroid therapy in an older patient.