Bullous pemphigoid

  1. Have any of you guys taken care of anyone with a disorder named bullous pemphigoid? It is horrible! CNAs are asking if what this person has is contageous and if it is going to kill this resident. This resident has huge blisters, some filled with blood and some with viscous fluid. They grow large then burst, leaving flattened scars that are becoming infected. She stays up all night just scratchng and scratching. We have mitts on her, but she scratches with the mitts. How does this disorder start? Only through forcing the doctor with an order to have the areas cultured did they find out it was bullous pemphigoid. She was first diagnosed with mosquito bites, then scabies, then impetigo, now this. I know this woman is miserable. Are there any treatments out there you guys know about that can help this woman other than steroids and immunosupressants?
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    About Nursebaby23

    Joined: Nov '04; Posts: 69

    22 Comments

  3. by   Tweety
    I don't have any suggestions to offer. I have seen one patient with this and it is indeed horrid to witness. Same scenerio as yours, we had to put mittens on and wrap her arms with rolls of gauze to keep her from scratching. We treated her as you said, with steriods.

    Good luck.
  4. by   LPNtoBSNstudent
    Yes, I have seen a few patients with it. As far as I remember, it is not contagious. It looks terrible though! I think it is auto immune disorder. I remember the first time I had a nursing home patient with it, everyone was freaking out like you described and the poor little old lady was just miserable. However, it did eventually go away after a month or so. I think she was put on steriods for it. But then I remember a few years later she got it again, not as bad.
  5. by   LPNtoBSNstudent
    More to add...

    A blister is natures perfect bandage, so it is best if they are left intact, in most circumstances. But I recall there was a huge amount of fluid in the blisters, almost inevitable that they will burst rather than reabsorb.

    I remember on the blisters themselves, when they burst, I think, we put non stick dressing on them with antibiotic ung and changed them every other day or something. It has been years ago.
  6. by   karenG
    it is horrible but not contagious though its ultimately fatal for the patient... takes a while though.

    seen a few people with it. I do have more info but at work. we usually dress the blisters with a film barrier dressing like opsite.. do you have that in the states?

    will dig out more info tomorrow

    karen
  7. by   RedBait
    Quote from Nursebaby23
    Have any of you guys taken care of anyone with a disorder named bullous pemphigoid? It is horrible! CNAs are asking if what this person has is contageous and if it is going to kill this resident. This resident has huge blisters, some filled with blood and some with viscous fluid. They grow large then burst, leaving flattened scars that are becoming infected. She stays up all night just scratchng and scratching. We have mitts on her, but she scratches with the mitts. How does this disorder start? Only through forcing the doctor with an order to have the areas cultured did they find out it was bullous pemphigoid. She was first diagnosed with mosquito bites, then scabies, then impetigo, now this. I know this woman is miserable. Are there any treatments out there you guys know about that can help this woman other than steroids and immunosupressants?
    Bullous pemphigoid (BP) is a chronic, autoimmune, subepidermal, blistering skin disease that rarely involves mucous membranes.

    BP is a chronic inflammatory disease. If untreated, the disease can persist for months or years, with periods of spontaneous remissions and exacerbations. In most patients who are treated, BP remits within 1.5-5 years. Patients with aggressive or widespread disease, those requiring high doses of corticosteroids and immunosuppressive agents, and those with underlying medical problems have increased morbidity and risk of death. Because the average age at onset of BP is about 65 years, patients with BP frequently have other comorbid conditions that are common in elderly persons, thus making them more vulnerable to the adverse effects of corticosteroids and immunosuppressive agents.

    Treatment is directed at reducing the inflammatory response and autoantibody production. Although target-specific therapy is the holy grail for immunodermatologists, non-target-specific treatments are currently used. The most commonly used medications are anti-inflammatory agents (eg, corticosteroids, tetracyclines, dapsone) and immunosuppressants (eg, azathioprine, methotrexate, mycophenolate mofetil, cyclophosphamide). A recent article from Europe provided evidence that strong topical corticosteroid treatment may achieve disease control while avoiding systemic adverse effects from systemic corticosteroids.

    This information was taken from an article found on eMedicine.com. It took me less than a minute to go there and search their database. It is a free site and contains massive amounts of information on medicine, disease, and drug therapies. Research is a good habit for a professional.
  8. by   Nursebaby23
    They have treated it with Kenalog cream, and now just started treating with bleach.
  9. by   karenG
    Quote from RedBait
    Bullous pemphigoid (BP) is a chronic, autoimmune, subepidermal, blistering skin disease that rarely involves mucous membranes.

    BP is a chronic inflammatory disease. If untreated, the disease can persist for months or years, with periods of spontaneous remissions and exacerbations. In most patients who are treated, BP remits within 1.5-5 years. Patients with aggressive or widespread disease, those requiring high doses of corticosteroids and immunosuppressive agents, and those with underlying medical problems have increased morbidity and risk of death. Because the average age at onset of BP is about 65 years, patients with BP frequently have other comorbid conditions that are common in elderly persons, thus making them more vulnerable to the adverse effects of corticosteroids and immunosuppressive agents.

    Treatment is directed at reducing the inflammatory response and autoantibody production. Although target-specific therapy is the holy grail for immunodermatologists, non-target-specific treatments are currently used. The most commonly used medications are anti-inflammatory agents (eg, corticosteroids, tetracyclines, dapsone) and immunosuppressants (eg, azathioprine, methotrexate, mycophenolate mofetil, cyclophosphamide). A recent article from Europe provided evidence that strong topical corticosteroid treatment may achieve disease control while avoiding systemic adverse effects from systemic corticosteroids.

    This information was taken from an article found on eMedicine.com. It took me less than a minute to go there and search their database. It is a free site and contains massive amounts of information on medicine, disease, and drug therapies. Research is a good habit for a professional.

    we use high dose topical steroids under a film dressing. last lady who had this died- rarely affects mucous membranes- well I can assure you it cant be that rare cos it affected her and she died a fairly horrible death! she was in her 50's and I got to know her very well. horrible...........

    Karen
  10. by   Nursebaby23
    ***This information was taken from an article found on eMedicine.com. It took me less than a minute to go there and search their database. It is a free site and contains massive amounts of information on medicine, disease, and drug therapies. Research is a good habit for a professional.[/QUOTE]***


    Trust me, I do have enough sense to look up or research anything I have a question about. I posted here because I wanted to know if anyone else has cared for someone with this condition. As a matter of fact I did go to emedicine before I posted here. Even though you can treat something like this with immunosupressants and steriods, I want to know what works that can be applied to the blisters. Most nurses have "recipes" that work for different things.
  11. by   karenG
    Quote from Nursebaby23
    ***This information was taken from an article found on eMedicine.com. It took me less than a minute to go there and search their database. It is a free site and contains massive amounts of information on medicine, disease, and drug therapies. Research is a good habit for a professional.
    ***


    Trust me, I do have enough sense to look up or research anything I have a question about. I posted here because I wanted to know if anyone else has cared for someone with this condition. As a matter of fact I did go to emedicine before I posted here. Even though you can treat something like this with immunosupressants and steriods, I want to know what works that can be applied to the blisters. Most nurses have "recipes" that work for different things.[/QUOTE]

    try topical steroids under a film dressing........ you only use a small amount of steroid. we got really good results for my lady- held her in remission for about 5 yrs before it began affecting her mucous membranes and then it was all over fairly quickly.. affected all her gut so she was unable to eat etc. we cleaned the ulcerated areas with N.saline and applied a small amount of steroid then the film dressing. did work- honest!!

    good luck

    Karen
  12. by   Nurse Berta
    When I was a wound care nurse I had 2 patients with this disorder. It is not contagious. I know it will frighten the staff, but tell them not to worry. Check her mouth periodically, because the lesions can appear there and prevent the patient from eating. It is an autoimmune disorder and the treatment of choice is steroids, both topical and systemic.
    Good luck
  13. by   edeverges
    Quote from Nursebaby23
    Have any of you guys taken care of anyone with a disorder named bullous pemphigoid? It is horrible! CNAs are asking if what this person has is contageous and if it is going to kill this resident. This resident has huge blisters, some filled with blood and some with viscous fluid. They grow large then burst, leaving flattened scars that are becoming infected. She stays up all night just scratchng and scratching. We have mitts on her, but she scratches with the mitts. How does this disorder start? Only through forcing the doctor with an order to have the areas cultured did they find out it was bullous pemphigoid. She was first diagnosed with mosquito bites, then scabies, then impetigo, now this. I know this woman is miserable. Are there any treatments out there you guys know about that can help this woman other than steroids and immunosupressants?
    i have taken care of a child that had an allergic reaction to a sulfa drug and i now work in long term care the treatments are similar see below and comfort measure.
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    Source: http://www.medicinenet.com








    Bullous Pemphigoid
    What is bullous pemphigoid?
    How is it diagnosed?
    How is bullous pemphigoid treated?
    What is bullous pemphigoid?

    Bullous pemphigoid is a disease characterized by tense blistering eruptions of the skin. The condition is caused by antibodies and inflammation abnormally accumulating in a certain layer of the skin called the "basement membrane." A majority of cases occur in persons 80 years of age or older.

    How is it diagnosed?

    Bullous pemphigoid is diagnosed based on the results of a skin biopsy, which can detect the abnormal antibodies deposited in the basement membrane layer of skin.

    Bullous pemphigoid-like condition can sometimes be associated with other illnesses, including systemic lupus erythematosus (SLE or lupus) and cancer.

    How is bullous pemphigoid treated?

    Bullous pemphigoid can be chronic and mild without affecting the general health of affected individuals. Treatment of bullous pemphigoid can resolve with topical cortisone creams, but sometimes requires high doses of cortisone ("steroids") taken internally. Severe bullous pemphigoid can also require immune suppression drugs, such as azathoprine (Imuran). Other treatments that have been used for severe disease include intravenous immunoglobulin infusions, typically given monthly.

    Recent research has indicated that large quantities of high-potency topical corticosteroids applied to the entire body surface were safer and more effective in controlling extensive bullous pemphigoid than oral corticosteroids. It was felt by the researchers that topical corticosteroids should now be the treatment of choice for bullous pemphigoid, particularly when the disease is not extensive.

    For further information, please read the Systemic Lupus Erythematosus, and prednisone articles.

    For further information on the internet about bullous pemphigoid, please visit the following site:

    Bullous Pemphigoid
    (http://tray.dermatology.uiowa.edu/BP001D.htm)



    Last Editorial Review: 3/29/2002




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  14. by   begalli
    How horrible! I can't imagine the torture of itching so bad but there are mitts on my hands or the parts that itch are inaccessible. Enough to make someone crazy, literally.

    Hopefully this poor woman gets something other than a topical for the itching? Like benedryl or another antihistamine? There is an IV drug we give to people with epidurals when they experience itching, but I can't think of the name of it right now. It seems to help.

    Awful, simply awful.

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