Bullous pemphigoid in an elderly woman: clinical recognition and management in internal medicine

Bullous pemphigoid is a chronic autoimmune subepidermal blistering disease mediated by circulating autoantibodies targeting hemidesmosomal proteins within the basement membrane zone. It predominantly affects elderly individuals and is clinically characterized by intense pruritus, tense blister formation, cutaneous fragility, and an elevated risk of secondary infection. Early manifestations are frequently nonspecific, often presenting as generalized pruritus or eczematous lesions, which may contribute to delayed diagnosis and management. In susceptible individuals, drug exposure has been identified as a potential triggering factor. Due to the risk of systemic complications and the often atypical initial presentation, internal medicine physicians commonly serve as the first point of contact, particularly in hospital settings, underscoring the importance of early recognition and appropriate referral for definitive diagnosis and treatment.