Although the itching blistering disease bulleus pemphigoid (BP) and another variant of the disease without blisters are becoming more common, they are still proving difficult to diagnose. If diagnosed correctly, however, they can be effectively treated. This is the conclusion of research carried out by Jorrit Terra, dermatologist at the University Medical Center Groningen, who discovered that a hormone cream could be used to treat both types of blistering disease safely and effectively. He will be awarded a PhD for his research by the University of Groningen on 30 October 2013.
BP is a serious blistering skin disease that is most prevalent in the over-70s. When infected, the patient’s entire body can be covered with itching blisters. The blisters and lesions can also occur in the mucous membranes. As people are growing older and researchers are finding better diagnostic methods, the disease is becoming more commonly diagnosed. In addition, the elderly take more medication and certain drugs (such as diuretics) are known to cause blistering diseases.
BP is a difficult diagnosis for GPs, and the atypical variant known as ‘pruritic non-bullous pemphigoid’ (PNBP) is even more difficult to diagnose. According to Terra, some 10-20% of BP patients do not develop blisters, making the disease even trickier for GPs, doctors in nursing homes and even dermatologists to identify. Doctors often prescribe medication for another skin disorder, such as eczema, scurvy or dry skin, to little or no effect. ‘So the message for them and the dermatologists is this: if you are treating an elderly patient for resistant itching without blisters, it could very well be PNBP’, advises Terra.
Terra’s research shows that the two blistering diseases can be treated safely and effectively with a hormone cream called clobetasol propionate. In many cases, this dispenses with the need for treatment prednisone pills. ‘Applying the cream is much more time-consuming than taking a pill. It must be rubbed in from top to toe for several months. But it has fewer side effects than prednisone, which can cause osteoporosis, diabetes and hypertension. The cream, which enters the blood via the skin, has practically no side-effects. Having said this, the hormones in the cream do cause thinner skin in some patients.’
J.B. Terra (Amsterdam, 1978) studied Medicine at the VU University Amsterdam, passing his doctor’s exams with honours in 2004. He conducted his PhD research in the Dermatology department of the University Medical Center Groningen. His thesis is entitled ‘Studies on clinical symptoms, diagnosis and treatment in pemphigoid diseases’. Terra works as a dermatologist at the UMCG.
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