Bullous Pemphigoid Pictures: How to Spot This Autoimmune Rash

Bullous pemphigoid is an uncommon autoimmune condition that affects the skin. People with bullous pemphigoid develop large blisters on their skin. Bullous pemphigoid isn’t contagious. But the blisters can be tender and painful. They can also get infected. If you’ve been experiencing bullous pemphigoid, here’s what you can expect — from healing times to treatment. 

What does bullous pemphigoid look like?

Bullous pemphigoid causes large blisters to form on the skin. But the condition looks different in different people. While almost everyone with bullous pemphigoid develops blisters, the size and location of the blisters can vary from person to person. Sometimes, people notice an itchy red or purple rash before the blisters develop. 

Bullous pemphigoid can vary in color, too. In fairer skin, the blisters are usually pink or red, but in darker skin, they may be purple, brown, or skin-colored. 

Blisters can develop anywhere, but the most common spots on the body where they develop include the:

• Armpits

• Elbows

• Inner thighs

The blisters are filled with clear fluid, which makes the skin over them feel tight and firm. Some people notice blood in the blisters, too. Sometimes, the skin around the blister is pink or red. 

The blisters can be tender to the touch. They may also be itchy. The skin beneath the blister may look more pink or red than usual. 

These blisters usually burst on their own within a few days. The skin crusts over and begins to heal. When blisters heal in darker skin, they can form light or dark patches that can take months to fade. Blisters can come and go for months or even years. 

Bullous pemphigoid pictures

Here are some examples of what bullous pemphigoid can look like in different locations and skin tones.

Two small, slightly pink fluid-filled blisters appear in the armpit.

A larger fluid-filled blister forms next to two smaller blisters.

One blister, amid a cluster of bullous pemphigoid blisters, has ruptured and is starting to scab over.

Intact and ruptured blisters from bullous pemphigoid are seen on a leg.

What causes bullous pemphigoid?

It’s not clear what causes bullous pemphigoid. Bullous pemphigoid is an autoimmune condition, which means that the immune system mistakenly attacks the body. 

In bullous pemphigoid, the immune system attacks the fibers that anchor the outer layer of the skin to the deeper layers of skin. This causes blisters to form. The inflammation can also cause itching and pain over the skin. 

Who’s at risk for developing bullous pemphigoid?

Bullous pemphigoid has been linked to several triggers. People exposed to these triggers may be at higher risk for developing bullous pemphigoid. You’re more likely to develop bullous pemphigoid if:

• You are over 60 years old: Most people who develop bullous pemphigoid are between 60 and 80 years old. People in this age group are more likely to be exposed to other triggers for bullous pemphigoid, like medications and certain medical conditions. This may be the reason they are at higher risk.  

• You have certain medical conditions: People with autoimmune conditions are more likely to develop bullous pemphigoid. People with a history of stroke, Alzheimer’s disease, and Parkinson’s disease are also at higher risk of developing the condition. 

• You take certain medications: People who take certain medications are more likely to develop bullous pemphigoid. It’s not clear if the medications themselves trigger the condition. Nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, gliptins, and amoxicillin have all been linked to bullous pemphigoid. 

• You have a history of skin damage or injury: People with a history of burns are more likely to develop bullous pemphigoid. Other things that can damage the skin, like radiation treatment, ultraviolet (UV) light exposure, skin surgery, and other skin injuries can also increase the risk. 

EXPERT PICKS: WHAT TO READ NEXT

• Autoimmune conditions aren’t all the same: Learn more about their similarities and differences with our autoimmune guide. 

• Guide to autoimmune rashes: Bullous pemphigoid is one of several blistering rashes. Learn more in our autoimmune rash guide.

• What’s it like to get a skin biopsy? Three people share their story with GoodRx.

But keep in mind that not everyone who falls into one of these categories will develop bullous pemphigoid. Researchers are still working to understand why certain people develop this condition while others don’t, even if they have the same exposures.

How serious is bullous pemphigoid?

Bullous pemphigoid is a long-lasting autoimmune condition. Blisters can come and go for weeks, months, or even years. 

A single blister can last for a few weeks, after which it will rupture and start to heal. But new blisters can form during this time, too. That means people can experience ongoing symptoms for weeks to months. 

Bullous pemphigoid can be uncomfortable and painful. Many people also feel uncomfortable with how blisters affect their appearance. 

The good news is that bullous pemphigoid doesn’t affect other parts of the body, and treatment can help you recover. 

How do you treat bullous pemphigoid?

If you have bullous pemphigoid, it’s important to work with a dermatologist. They can help you find the best treatment for your symptoms. Treatments for bullous pemphigoid can include:

• Steroids: Steroids lower inflammation. Your dermatologist may recommend a topical steroid to put on your blisters. Oral steroids, like prednisone, are an option if you have blisters covering a large part of your body. 

• Antibiotics: Antibiotics like doxycycline, and dapsone, also help lower inflammation. They can also help treat skin infections. People with bullous pemphigoid are three times more likely to develop serious skin infections than people without bullous pemphigoid.

• Immunosuppressants: Immunosuppressants such as mycophenolate mofetil and methotrexate can calm the immune system.

• Biologics: Biologics like dupilumab or rituximab change how the immune system reacts instead of suppressing it.

Your dermatologist may recommend a combination of treatments to help ease your symptoms and stop future flares.

Why trust our experts?

Written by:

Jonathan Santana, DO

Jonathan Santana, DO, is a board-certified and fellowship-trained pediatrician, with board certification in primary-care sports medicine. He has been in academic practice for 8 years as an assistant professor in orthopedics.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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Images used with permission from VisualDx (www.visualdx.com).