Autoimmune Disease

• BP is an auto-immune disease. The body's immune system creates antibodies to fight off disease-causing agents. In an auto-immune disease, auto-antibodies attack the body's own cells. The cells which trigger this attack are called auto-antigens.
  
  In BP, auto-antibodies are created which attack the membrane that lies between the two top layers of the skin, the epidermis and the dermis. Fluid builds up between these two layers, causing blisters.
  
  

Effects

• Initially, itchy eczema-like patches of skin develop. Weeks or even months later, firm, dome-shape blisters develop. These are filled with fluid which may be clear, cloudy or blood stained. They usually appear in the armpits, groin and on the legs, but they can occur anywhere, including inside the mouth and on the scalp.
  
  It may be several days before the blisters burst and some do not burst at all; the fluid is reabsorbed and the blister collapses back onto the skin. Generally, there is no scarring.
  
  

Identification

• A small skin sample is examined under a microscopemicroscope kit image by PHOTOFLY from Fotolia.com
  
  Before the blisters appear, BP can be difficult to diagnose visually.
  
  In the initial stages, it resembles eczema, an allergic response or many other skin diseases and disorders.
  
  Definitive diagnosis is made by taking a biopsy in which a small sample of skin is examined microscopically. The specific antibody can also be detected in blood, fluid drawn from blisters and urine.
  
  

Hair Loss

• Bullous pemphigoid mainly occurs in older peopleold people beach huts image by david hughes from Fotolia.com
  
  While hair loss is associated with several other blistering skin diseases, such as pemphigus vulgaris and epidermolysis bullosa, there is little or no research which specifically reports hair loss as being associated with BP.
  
  Because the disease generally occurs in older people, some hair loss may already be present and some drugs used to treat the disease, such as cytotoxic agents, are known to be associated with hair loss.
  
  

Theories/Speculation

• Auto-antibodies attack a genetic proteinadn ? image by G.g1 from Fotolia.com
  
  Research in the Polish Journal of Pathology states: "the main auto-antigen in bullous pemphigoid is BPAG2", a genetic protein which adheres the epidermis to the dermis. It is this protein which the auto-antibodies attack.
  
  The Journal of Investigative Dermatology reports that mutations in this gene are associated with a type of hair loss called diffuse scarring alopecia. Merck Manuals defines this alopecia as being the result of irreparable damage to the hair follicle, such as may be caused by chemotherapy.
  
  BP therefore may be associated with hair loss anywhere on the body as a result of genetic mutation in a specific gene.
  
  

Summary

• BP is a rare auto-immune disease which mostly affects older people and which is characterized by tense, fluid-filled blisters. These slough off, leaving patches of raw skin which may become sore and infected.
  
  There is no cure but the disease can be controlled with steroids, though sometimes cytoytoxic drugs are used. It is a self-limiting disease which may last for one to ten years.