Vet’s 2025 Guide to Canine Bullous Pemphigoid Blisters, Diagnosis & Management🩺

By Dr. Duncan Houston BVSc

💡 What Is Bullous Pemphigoid?

Bullous pemphigoid is a rare, autoimmune skin disorder in dogs where antibodies attack the attachment between the epidermis and dermis, causing tense blisters (bullae) and ulcers 🩹. Left untreated, it may become severe or life-threatening.

🚩 Who Gets It & Why?

• 📉 Very rare—often <10 % of canine autoimmune blistering diseases.
• 🐕 Breeds predisposed: Collies, Shetland Sheepdogs, Dobermans; also seen in Dachshunds and German Shepherds.
• ⚥ Males affected ~2× more than females.
• 🧬 Autoimmune attack against BP180/BP230 proteins in basement membrane.

👀 Clinical Signs & Presentation

• 🔵 Tense, fluid-filled blisters (bullae) on skin and mucous membranes (mouth, lips, armpits, groin).
• 🔴 Crusts, ulcers, erythematous patches—blisters often rupture.
• 🫁 Itching, discomfort, potential anorexia or depression if oral lesions are present.
• 🐾 Blisters form in flexural areas & footpads; mucocutaneous junctions involved in ~67 % cases.

🧪 How It’s Diagnosed

• Clinical signs + breed/history raise suspicion.
• Skin biopsy from intact blister for histopathology (subepidermal cleft, neutrophils/eosinophils).
• Direct immunofluorescence: linear IgG/C3 deposits along basement membrane.
• Indirect immunofluorescence/ELISA may detect circulating BP180/BP230 antibodies.
• Rule out other blistering diseases: pemphigus, discoid lupus, infectious or drug-induced causes.

🩺 Treatment Strategies

1. Immunosuppressive Therapy

• 💊 High-dose prednisone or prednisolone: initial therapy to suppress blister formation.
• ⚖️ Steroid-sparing agents often required:
• Azathioprine, mycophenolate, methotrexate, or chlorambucil.
• Topical corticosteroids (e.g., clobetasol) for localized cases.

2. Supportive Wound Care

• 🛁 Clean serrated lesions with antiseptic and apply barrier ointments.
• 🧴 Topical antibiotics if secondary infection is suspected.
• 🩹 Pain management and ensuring hydration and nutrition, especially if mouth lesions are present.

3. Monitoring & Long-Term Follow-Up

• 📅 Recheck every 2–4 weeks during induction, then every 3–6 months once stable.
• 🩺 Track skin lesion counts, pruritus, and mucosal involvement.
• ⚠️ Monitor side effects from steroids/immunosuppressants: bloodwork, blood pressure, weight, bone density.
• 📉 Taper medications slowly: reduce steroids and maintain minimal effective immunosuppression.

📈 Prognosis & Outcomes

• 🔁 May resolve spontaneously but often relapses occur without treatment.
• 🩺 Good control achievable with combination therapy, but lifelong maintenance may be needed.
• 🦠 Secondary infection is the main risk for morbidity; early treatment improves outcomes.

🚫 Tips & Preventive Strategies

• ⚠️ Avoid known triggers—sunlight, certain drugs (e.g., furosemide, NSAIDs).
• 🐾 Prevent trauma to affected areas—soft bandaging may help.

🏡 Ask A Vet App Home‑Support Tools 📲🐶

• 📆 Schedule med reminders & wound care routines.
• 📊 Log lesion counts, itch scale, appetite, mood.
• 📸 Upload lesion photos for remote vet input.
• 🔔 Alerts for new blisters, poor healing, or infection.
• 📚 Guides on wound cleaning, medication handling, and side-effect flags.

🔑 Key Takeaways

• Bullous pemphigoid is a rare autoimmune blistering disease in dogs.
• Diagnosis requires biopsy & immunofluorescence.
• High-dose steroids plus immunosuppressants are the mainstay of therapy.
• Careful skin care, monitoring for infection, and slow tapering are essential.
• Life-long management may be needed due to risk of recurrence.
• Ask A Vet app offers structured home monitoring and vet support tools.

🩺 Final Thoughts ❤️

In 2025, early detection and aggressive treatment of bullous pemphigoid allow dogs to lead comfortable lives. Though rare, this condition can be managed effectively with immunosuppressive therapy, proper wound care, and consistent follow-up. Ask A Vet empowers owners to recognize flares, track disease progress, and stay connected to veterinary guidance—keeping pups happy and healthy 📲🐾.

Visit AskAVet.com and download the Ask A Vet app to log medications, document lesions, set alerts, upload photos, and receive expert support anytime. 📲🐶