A distinctive clinical image depicting bullous pemphigoid in a 77-year-old male

Bullous pemphigoid is a chronic, acquired autoimmune blistering disorder of the skin characterised by the formation of tense subepidermal bullae. It primarily affects elderly individuals and represents the most common autoimmune blistering disease in this age group. The condition arises from an abnormal immune response directed against structural proteins of the basement membrane zone, leading to loss of adhesion between the epidermis and dermis. A 77-year-old male was admitted for evaluation and management of multiple fluid-filled skin lesions involving the entire body. The patient was asymptomatic until five months ago, when he developed itchy, fluid-filled lesions over the right arm that were insidious in onset and gradually progressive. The lesions were often ruptured by the patient or ruptured spontaneously, resulting in painful, burning erosions. Despite multiple courses of oral and topical treatment prescribed by private practitioners, there was no improvement, and similar lesions progressively appeared over the body over the next three months. The condition worsened in the past few days, prompting referral from a government hospital to a higher centre. On examination, there were multiple intact tense bullae with few erosions distributed over the body. Based on clinical findings, a provisional diagnosis of bullous pemphigoid was made, and the patient was admitted to the dermatology ward and started on electrolyte replacement supplements, Momonova-F cream, Oilatum lotion, antibiotics, potassium permanganate baths and soaks for further management.