Which blistering disease is typically subepidermal and most common in the elderly?

Which blistering disease is typically subepidermal and most common in the elderly?

• A. Bullous pemphigoid
• B. Pemphigus vulgaris
• C. Dermatitis herpetiformis
• D. Stevens-Johnson syndrome

Answer: (A)

Bullous pemphigoid is the blistering disease that fits this description. It forms subepidermal blisters due to autoantibodies against hemidesmosomal proteins at the dermal-epidermal junction, causing separation just beneath the epidermis. This leads to tense bullae that commonly occur in older adults, with mucosal involvement typically minimal and Nikolsky sign usually negative. In contrast, pemphigus vulgaris produces intraepidermal (above the basement membrane) blisters from anti-desmoglein antibodies, with fragile bullae, positive Nikolsky sign, and often mucosal involvement. Dermatitis herpetiformis can also be subepidermal but presents as intensely pruritic vesicles on extensor surfaces and is linked to gluten sensitivity, not the typical elderly-prevalent pattern. Stevens-Johnson syndrome involves widespread epidermal necrosis rather than subepidermal blistering.

Bullous pemphigoid is the blistering disease that fits this description. It forms subepidermal blisters due to autoantibodies against hemidesmosomal proteins at the dermal-epidermal junction, causing separation just beneath the epidermis. This leads to tense bullae that commonly occur in older adults, with mucosal involvement typically minimal and Nikolsky sign usually negative. In contrast, pemphigus vulgaris produces intraepidermal (above the basement membrane) blisters from anti-desmoglein antibodies, with fragile bullae, positive Nikolsky sign, and often mucosal involvement. Dermatitis herpetiformis can also be subepidermal but presents as intensely pruritic vesicles on extensor surfaces and is linked to gluten sensitivity, not the typical elderly-prevalent pattern. Stevens-Johnson syndrome involves widespread epidermal necrosis rather than subepidermal blistering.